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Document Title: JohnsonShelbourne-AJARS-Feb03
Article Title (Point-Counterpoint): Anterior cruciate ligament reconstruction: A cynical view from the British Isles on the indications for surgery
Author: Donald H. Johnson, M.D., Nicola Maffulli, M.D., M.S., Ph.D., F.R.C.S.(Orth), John B. King, F.R.C.S., K. Donald Shelbourne, M.D.
Publication: Arthroscopy: The Journal of Arthroscopic and Related Surgery
Date: February 2003.
Volume 19, Number 2, pages 203-209
(Reference-denoting numbers appear in the same point size as document text.)
This excellent and highly readable discussion of whether or not to reconstruct a fully torn ACL brings forth a plethora of very thought-provoking points. Many, many patients with unstable and deteriorating knees find themselves confronted with a surgeon whose recommendation seems to give more weight to financial concerns. Dr. Shelbourne, a famous knee expert and highly articulate researcher, brings forth numerous good reasons in favour of prompt ACL reconstruction. He also does an excellent job of refuting the widespread misinterpretations stemming from Noyes' "rule of thirds". He points out the regrettable aspect that in some countries (in this example, the United Kingdom), the government-bean-counter-imposed restrictions on ACL reconstruction (i.e. "ACL reconstruction shall only be done for already-severely-damaged knees") naturally means that the results of ACL reconstruction are not as good as they could be. ACL reconstruction brings the best possible results only when the knee is not allowed to incur the damage of repeated giving-way incidents. So, health-insurance accountants who consider ACL reconstruction to be too expensive must be reminded of the enormous long-term costs that come with the accelerated knee degeneration that is an inevitable consequence of a knee that manifests itself as unstable. Shelbourne concludes his brilliant missive by deftly pouncing on Maffulli and King's use of dated, obsolete references.
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