Advanced Knee Care

Knee Surgeon and Specialist Stefan D. Tarlow, M.D.

Return-to-Sport Rate After Anterior Cruciate Ligament Reconstruction

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Eric Hamrin Senorski, PT, MSc, PhD*, Eleonor Svantesson, MD, MSc, Susanne Beischer, PT, MSc, …

First Published April 16, 2018 Research Article 

Can Athletes return to Strenuous Sports 1 Year after Surgery for a Torn ACL Knee?  The answer is yes, but not all.
We continue to learn about return to sport after ACL knee injury.  Not all patients return to their sport.  This study looks at patient characteristics, meniscus and MCL injury, and graft choice at primary ACL reconstruction.  Can these factors predict return to sport (RTS) 1 year after surgery.  Data were extracted  Swedish National Knee Ligament Register. Twelve months after surgery, all patients were evaluated for RTS via the Tegner Activity Scale. The primary outcome was a return to knee-strenuous sport, defined as a Tegner Activity Scale ≥6.

Results:

A total of 272 patients (51% female)age of 16-34 years were included. In the multivariable analysis, a favorable odds ratio (OR) for returning to sport was found for patients of male sex, younger age at the time of ACL reconstruction , a higher preinjury score on the Tegner Activity Scale, and an absence of injury to the meniscus  and medial collateral ligament.  Graft choice did not effect Return to Sport.

Conclusion:

Positive predictors of a return to knee-strenuous sport 1 year after ACL reconstruction were male sex, younger age, a high preinjury level of physical activity, and the absence of concomitant injuries to the medial collateral ligament and meniscus.

Graft choice did not effect Return to Sport.  (Dr. Tarlow comment: autograft BTB (patella), autograft hamstring, autograft Quad tendon is graft of choice in this age of patient.  Allograft of all types contra – indicated in this age group)

Filed Under: ACL

Return to Sport and Reinjury After ACL Reconstruction in Young Athletes

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ACL surgery is common in high school and adolescent athletes.  Many return to sport at an average of 10 months after surgery.

The most common grafts used in this age group are hamstring and patellar tendon autografts (from the patient-not cadaver).

91 % of athletes returned to sports at an average of 10 months.  The 9 % that did not return were physically able to return but made a decision not to risk reinjury to either knee.

19 % of the patients re-tore the ACL in the same knee and 13 % of patients re-tore the ACL in the opposite knee.  The prevalence of a second ACL tear was 32 %.  The data in this study showed an earlier return to sport in this age group increased the likelihood of ACL re-tear (either knee).

We still have a lot to learn about young athletes and ACL tear.  Two things are certain.  The re-tear rate for each knee is high and early return to sport is a risk factor for repeat ACL tear.

ACL Surgery Technique Determines Successful Return to Activity

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Anterior Cruciate Ligament Surgery Technique Determines Success in ​Return to Activity for Athletes

Performing the surgery in a Technically correct manner gives my patients the best chance for a well functioning knee after ACL injury.   The transition from Transtibial to Anatomic Femoral tunnel drilling started approximately 2008 and by 2013 most surgeons had evolved.  Patients that had ACL reconstruction prior to 2008 may be candidates for revision ACL surgery.   In 2017 most, but not all ACL surgeons are proficient in the Anatomic Tunnel technique.   Outcomes after ACL reconstruction are highly dependent on precisely how the surgery is performed.  This blog post is a bit more technical than my average post.  This is intended for the lay person who wants to learn about the technical nuances of acl reconstruction of the knee.​

The surgical technique used during ACL reconstruction varies widely not only from country to country but even within departments of the same hospital. Surgeons choose from arthroscopic vs open surgery, intra vs extra-articular reconstruction, graft choice, single vs double bundle method and graft fixation.  However, all these issue are of secondary importance to FEMORAL TUNNEL and TIBIAL TUNNEL location.  An anatomic Femoral Tunnel location created by drilling through an accessory medial arthroscopic portal creates the femoral tunnel in the ideal location.  The success of your ACL surgery is most dependent on this tunnel placement.  Tibial tunnel placement is also important and should not be placed too far posterior.  ACL tunnels that vary outside of these known landmarks result in limited knee motion (tight knee), graft failure by rupture, and graft failure by recurrent instability (even when graft appears “intact” on post op MRI).  The explanation for this failure is that the anatomical approach brings the tunnel layouts to a more horizontal position, which is biomechanically better  (studies have shown it provides better stability to both anterior-posterior and the internal rotational).
 
 Anatomic ACL reconstruction will increase result in better outcomes of  in short and the long term for injured athletes.
 
Femoral tunnels created by a transtibial approach will cause the ACL graft to spread outside of the natural adhesion areas and lead to abnormal knee kinematics Anatomic tunnel surgery technique provides better relocation of the graft in terms of kinematics of the knee. Therefore, this technique combined with good rehabilitation has better activity outcomes in terms of sport and regular life compared to the transtibial technique.
A clinical study concluded that the use of the anatomic replacement of the ACL resulted in greater knee stability and range of motion values and an earlier return to running compared to the transtibial technique.

Should I Wear a Custom Knee Brace after ACL Knee Surgery?

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acl knee surgery

ACL is one of the major and most important ligaments found in the knee. It is also susceptible to tear and injury. This kind of injury is common among athletes, particularly those playing sports which involve sudden changes in direction, stops, and jumping. ACL tear is a serious injury in the knee. If you have this, it becomes too painful and unstable for you to bear your own weight.

ACL tear can be treated in various ways, depending on the severity of the injury. However, in worst cases, reconstructive surgery is necessary. Patients undergo ACL knee surgery to fix their injury. This is followed by months of rehabilitation. After the rehabilitation, the athletes and other individuals who have undergone such reconstructive surgery will find themselves returning to their normal lives.

Many patients, particularly athletes, use knee brace to protect their knee from reinjury and to help them be quicker and stronger in doing functional activities like jumping, pivoting and running. So the question now is: should one wear a custom knee brace after ACL knee surgery?

There is no scientific data that supports this. It is true that wearing functional ACL brace helps protect the knee from twisting forces. It may also protect the implanted ACL graft particularly during the rehabilitation period. Some athletes feel more confident and safe when they are wearing a brace. They feel that it helps joint position and lowers their fear of reinjury. They believe that the ACL brace will prevent reinjury during the transition back to their normal lives and activities.

However, there is no scientific evidence that supports this belief. Based on scientific data, it is not yet proven that ACL brace help decrease the rate of reinjury. Not to mention the fact that the effectiveness of the brace diminishes as the activity levels increase.

Nevertheless, braces do increase the patient’s confidence in themselves, which psychologically helps them live and functionally normally again. Braces also protect healing tissues during the rehabilitation period.

Going back to the question, should one wear a custom knee brace? Yes, though it does not totally guarantee that you will be free from reinjury. Knee brace definitely helps in promoting a smoother and more efficient transition back to work or sport. In fact, in selected patients, ACL braces are prescribed as part of the rehabilitation program. They are advised to use ACL brace 3 to 12 months after the reconstructive surgery.

If you still have doubts whether to use custom knee brace after the ACL knee surgery, you can simply ask your orthopaedic surgeon. Make an appointment with our “knees only” orthopaedic surgeon so we can cater to your needs and concerns.

ACL Reconstruction Recovery

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ACL reconstruction knee surgery includes repairing or reconstructing the ACL, which is the anterior cruciate ligament. This type of surgery benefits the athletes who have injured or torn their ACL.

Effective, efficient recovery and patient satisfaction are two of the most important goals after ACL reconstruction knee surgery. This is done by restoring the normal stability of the knee, as well as the level of function. It also helps prevent degeneration and possible injuries in the future.

ACL Reconstruction Recovery

How effective is ACL reconstruction, especially when it comes to the return to play aspect? Let us take a look into a study conducted in New York. The study involved 230 patients and the results of which were published in the Journal of Bone and Joint Surgery in 2017. Based on the study, the efficient recovery and patient satisfaction are high after ACL reconstruction recovery in active athletes. The results and findings of the study are reported and recorded as follows:

  • 87 % of people returned to play by a mean of 10 months (range 3-17 months)
    Most notably, patellar tendon autograft patients had the highest likelihood of return to play. However, it was found out that participation in soccer and lacrosse decreased the odds of returning to play; as such sports require strenuous and intense usage of the knees and legs.
  • 95 % of people were satisfied with their surgical outcome, most of which are athletes. Moreover, 98% of patients stated they would undergo the surgery again. This goes to show that the patients who have undergone ACL reconstruction felt stronger and more confident after the procedure.
  • However, there are patients who are concerned about the “strength” of their knee. In fact, this is the most common reason why patients are afraid to or have doubts of returning to play.
  • But overall, patients who returned to play were very satisfied with their surgical results.

The important thing about ACL reconstruction is its effects and satisfaction rate. You may not be able to restore the same function as the original, but at least you will still be able to return to play and engage in sports and other activities.

If you wish to know more about ACL reconstruction, how it works, what are the risks and others, check out Tarlow Knee. We perform ACL reconstruction and other knee surgery. Make an appointment with us today.

Total Knee Replacement After ACL Reconstruction

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Total knee myths

Suffering from a knee injury or advanced arthritis in the knee makes it hard for one to perform even simple activities like walking. Some still feel pain and discomfort even when lying down or sitting. In some cases, using walking supports and taking medications may be helpful. However, some consider total knee replacement as a viable option to correct the deformity and relieve the pain, among others.

Impact of Arthritis After ACL Reconstruction

According to a new study, people who have undergone reconstructive surgery such as total knee replacement have high chance of developing wear-and-tear arthritis, three times more in the injured knee than in the injured one (as published in the American Journal of Sports Medicine, 57 percent of patients who had ACL-reconstructed knees).

The risk of advanced arthritis in knee following successful ACL knee ligament reconstruction is greatly increased (50 percent greater) over the uninjured population. When a patient undergoes Total Knee Replacement (TKR) surgery in this setting it is not just a routine surgery.

TKR operative time is significantly longer and the risk of reoperation due to various causes (infection, stiffness, instability) is 5 times higher than the control group.

Total Knee Replacement Precautions

There are several precautions that the patient must undertake in order to achieve a safer and more successful total knee replacement. This includes several evaluations, tests and planning.

  • Medical Evaluation

Physical examination for medical evaluation may be necessary weeks prior the scheduled operation. This is a precaution to make sure that you are in good health and shape to undergo the surgery successfully. The safety of the patient is of paramount importance.

  • Tests

There are several tests that you may need to take as part of the plan of your surgery. Usually, the tests include electrocardiogram and taking urine and blood samples. In line with this, people with a history of urinary infections need to undergo urological evaluations before the surgery. The required treatments must be completed first before undertaking total knee replacement surgery.

  • Medications

The surgeon needs to know what medications you are taking for your advanced arthritis in knee or any condition for that matter. This is important as there are certain medications that you need to refrain from taking before the surgery.

  • Social Planning

You need to plan ahead, especially for period immediately after the surgery. You need someone to assist in you in things during the recovery period. Aside from the fact that you will need crutches or walker after the surgery, you also need to have a company to help you with your daily activities. If you live alone, you can plan that ahead so you can arrange with someone or a professional to be with you until you have fully recovered.

Assessing the Appropriateness of Total Knee Replacement Surgery

You must remember that having a total knee replacement surgery for advanced arthritis in knee or injury takes more than just yourself. You must also cooperate with your surgeon, your physician and your family. You need to be fully assessed to determine if you really need to undergo surgery and what will you benefit from it.

The following are the most common instances when patients are recommended to undergo knee replacement surgery:

  • Knee deformity.
  • Moderate and severe knee pain.
  • Chronic knee inflammation and/or swelling which do not improve even when you have been taking medications.
  • Severe knee pain or stiffness that makes it hard for you to walk and do everyday activities.
  • Common treatments like injections, therapies and medications have not proved to be beneficial to your condition.

The recommendations for the surgery are based on the patient’s disability and pain. Age is not a factor, as there are no age or even weight restrictions before the surgery can be performed. However, most patients that undergo such procedure age from 50 to 80. This is because these are the ages when arthritis is common. Overall, with proper precaution and evaluation, total knee surgery may prove to be successful, regardless of the patient’s age.

If you have advanced arthritis in knee or injury and if you are looking for effective treatments with high chance of success, checkout Tarlow Knee today. We have extensive experience treating knee conditions and can help you find the right solution for you.

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