Knee Issues Physical Therapy in Pittsburgh

Q: Ten years ago, I tore my ACL. I didn't have insurance at the time, so I waited five years before I had the surgery to repair the problem. Everything seems to be working out but I always wonder if that delay will make a difference in the end.

A: Surgeons and researchers who study the problems associated with anterior cruciate ligament (ACL) tears are finding that certain factors increase the risk of poorer outcomes. A delay between the date of trauma and the date of surgery does appear to be a risk factor for problems later.

In one ultra long study over a period of 25 years, 100 patients were followed. Throughout those years, risk factors that could affect outcomes were evaluated. For example, data has been analyzed on the effects of age, surgical delay, joint laxity or looseness after surgery, removal of the entire meniscus, and damage to the joint cartilage. Mostly what they were looking at was how much degeneration occurs in the joint and whether any of those risk factors contributed to the problem.

Osteoarthritis was judged based on X-rays by looking at the size of the joint space and presence of bony spurs around the joint. Narrowing of the joint space was seen as a result of degenerative deterioration, especially in those patients who had medial meniscus damage or removal. Patients who waited three or more years to have surgery after injuring the ACL were more likely to develop osteoarthritis later.

So it appears that delay after injury and before surgery can make a difference. But with everything else we've learned over the years, every effort is being made to prevent postoperative complications.

A good exercise program to keep the muscles around the knee toned and strengthened is important. Alignment of the foot, ankle, and knee are also important. Sometimes something as simple as a shoe orthotic (insert) can make a big difference.

If you have any reason to suspect there are problems developing, don't wait to make an appointment with your surgeon. An evaluation five years after surgery isn't a bad idea and may provide you with the information you need to keep that knee healthy and strong for a very long time.

Reference: Jerome Pernin, MD, et al. Long-Term Follow-Up of 24.5 Years After Intra-Articular Anterior Cruciate Ligament Reconstruction with Lateral Extra-Articular Augmentation. In The American Journal of Sports Medicine. June 2010. Vol. 38. No. 6. Pp. 1094-1102.