Saturday, August 28, 2010

To Repair ACLs--Or Not?

Wow--Michele of Just A Thought posted on a really confounding study, cited by the New York Times earlier in August, that found people who just went through rehab after tearing their ACL had just about the same outcomes in terms of pain and function of their knees as people who, like Michele, me and lots of others, went through ACL reconstruction surgery.

My first reactions were 1) that can't be true, and 2) I went through all that pain for nothing?

I don't know what I think at this point. I do know that I was repeatedly collapsing on the floor in martial arts class due to the instability of my knee--and it's highly likely that those collapses contributed to the meniscus tear that also got repaired during my ACL surgery. Perhaps immediate physical therapy would have strengthened my leg enough I wouldn't have had those collapses.

There's no question that a leg with ACL reconstruction is more stable, it seems. The question is just how important that stability is.

Part of the back and forth about ACL surgery in the article was:

“Most subjects can do in-line activities” like running or biking “without an A.C.L.” He [an ACL surgeon] adds, “On the other hand, we believe that A.C.L.-deficient subjects that do return” to sports involving cutting, pivoting or planting the leg “can consequently injure the meniscus” or other cartilage in the knee and would benefit from a replacement A.C.L.
The authors of the study are less sure. “On the basis of our study results, we’d tell patients” that “there is no apparent downside of starting a good rehab program and waiting with the surgery decision to see if it is needed or not,” the authors wrote to me.

Well, I've done ACL surgery, and I feel it allows me to pivot, balance on one leg, and absorb blows better than I would have been able to do. But there clearly are some downsides to ACL surgery, including intense pain and a long recovery period. As Black Belt Mama's horrific experience shows, not all ACL surgeries work out--she just had to have new surgery to repair damage from unsuccessful ACL surgery.

And frankly, it's a little creepy to me that my left leg has never quite grown back in size to match the right leg--it's not that I look like I had polio or anything, but if you look closely you can usually see the difference.

There's one black belt in our school who had a torn ACL years ago and who never got it repaired. She's a terrific black belt, and has all her functionality in sparring (she's a "little thang," maybe 5'3" or so, but she can kick me in the head!). She does wear a brace when she spars. She doesn't grapple, where I assume the brace would get in the way.

I'm not going to regret getting ACL surgery and having a more stable knee. But I think I will advise my friends who have injured ACLs and who haven't gotten surgery yet to consider physical rehab before they decide on getting the surgery.

Many thanks to Michele for pointing this article out.


Anonymous said...

I tried 6 weeks of therapy before having surgery. I had NO stability. The stability that I did have was built up scar tissue that when I pivoted, broke up and I was right back where I started. I absolutely had to have it repaired. If I hadn't received that bioscrew in the tibia, I would have been just fine I think. Hopefully now I'm totally on the mend. It feels WONDERFUL to have that screw out. I just don't buy that surgury isn't necessary. If all you want to do is walk a straight line, go for it. But I wasn't going to be satisfied if I couldn't be normal again.

Michele said...

Hi Bob. I was surprised when I read the article. I would have expected a huge difference in the outcomes.

I agree with you and BBM. I had to have the surgery. It still makes me queasy remembering how it felt when my leg would slide out of position.

BobSpar said...

Interesting, I had a conversation with the student at our school, a second-degree black belt, who didn't have the surgery, and she now wishes she did. Maybe it's acceptable for a lot of sports not to have the surgery, but essential in martial arts.