According to the Arthritis Foundation, "Studies have shown that a torn ACL leads to OA in more than half of affected knees five to 15 years after injury."1
The ACL is one of the four major ligaments in the knee whose job it is to attach the femur to the tibia, providing stability for the knee.2 Injuring this ligament can involve many things, but in this post we'll focus on specifically ACL tears. ACL tears are most common among athletes who participate in sports such as basketball, soccer or skiing, which involve the shifting of weight from one leg to the other in order to change directions quickly or other similar movements. Usually, a repair requires an extensive reconstruction surgery in which a donor tendon from a cadaver is implanted into the patient.3
From what I found, there is a direct link between ACL injuries and osteoarthritis but that there is new evidence for preventative measures to what currently seems to be the inevitable. Two doctors working independently from each other, one in Detroit and the other in Pittsburgh, both found that the procedure in which surgeons were going about repairing the torn ligament was not necessarily being done with the patient's best interests in mind.3As previously mentioned, surgeons repair the torn tissue with a tendon from a donor, but to be as non-invasive as possible, they only make a few small incisions and then proceed with cameras. With this technique they are able to attach the tendon successfully to the area most easily accessible.3 The problem with this though becomes that of specificity; not all peoples' bodies have the exact same anatomy and it is this simple fact that may be causing a lot of the issues patients have with osteoarthritis. A tendon not attached in the most ideal place for that person will naturally cause problems and perhaps osteoarthritis. These two doctors are now addressing this issue and with the help of the NIH are embarking on "groundbreaking research project that could result in more ACL tear sufferers regaining normal knee function and diminish substantially the number who suffer from arthritis in later years."3
References:
- Neuman, P., M. Englund, and I. Kostogiannis. "OA 15 Years After ACL Tear." Arthritis Foundation | Symptoms Treatments | Prevention Tips | Pain Relief Advice. N.p., 15 May 2008. Web. 4 Nov. 2012. <http://www.arthritis.org/oa-acl-tear.php>.
- Anterior cruciate ligament. (2012, October 29). In Wikipedia, The Free Encyclopedia. Retrieved 05:34, November 5, 2012, from http://en.wikipedia.org/w/index.php?title=Anterior_cruciate_ligament&oldid=520508874
- Kelly, Jack. "Does ACL surgery cause arthritis? UPMC team seeks answers - Pittsburgh Post-Gazette." Pittsburgh Post-Gazette. Pittsburgh Post-Gazette, 29 Mar. 2012. Web. 5 Nov. 2012. <http://www.post-gazette.com/stories/news/health/does-acl-surgery-cause-arthritis-upmc-team-seeks-answers-275375/>.
Brynne, interesting stuff. I had no idea of the association between ACL tears (or the surgery) and OA. Outside of the surgery and differing anatomy between the donor and patient, is there some type of immune response against the foreign tendon? The following are videos that support the advancements of the whole process and likely an athlete that is a freak of nature [it used to be a death sentence (career wise) to NFL players just like Tommy John surgery to baseball players - predominately pitchers].
ReplyDeleteAdrian Peterson tore his ACL (and MCL) on December 24th, 2011:
http://www.nfl.com/videos/nfl-game-highlights/09000d5d8255fd8e/Peterson-down-and-out
Here he is less than a year later, October 25th, 2012:
http://www.nfl.com/videos/nfl-game-highlights/0ap2000000085294/Peterson-64-yard-TD-run
And again on November 4th, 2012:
http://www.nfl.com/videos/nfl-cant-miss-plays/0ap2000000089836/WK-9-Can-t-Miss-Play-Peterson-74-yard-run
As Curtis mentioned I also haven’t heard that ACL surgery can cause OA. I actually tore my ACL about 4 years ago when I was playing soccer at school. I have to say it is really painful if you try to do some activity and your joint moved a little before having a surgery. After the surgery I had to go through physical therapy and wait for 6 month before playing sports. It healed very well and I still play soccer again.
ReplyDeleteIn order to avoid immune response, the surgeon can remove some tendon from the front of your knee and use it as a replacement for your ACL. I think if they used the tendon from a donor you might have to take immunosuppressant drugs for the rest of your life. In my case I think the surgeon that did my surgery used my own tendon because I didn’t have any immune response and I don’t have to take any medications.
I never thought about a torn ACL and the surgery to follow, to cause OA. Now that you've mentioned it though, it makes a lot of sense. With a torn ACL, the replacement is non-self, so it would make sense for the replacement potentially causing wear and tear. It's like a hip replacement... one of my family friends got a hip replacement, and although some of her past problems have been solved, she is dealing with arthritic like symptoms now. I'm not sure if she has been diagnosed with arthritis though. The ACL surgery would be similar and cause similar effect. The original knee was the body's best version of it, now that a replacement has been put in, it will never be as good as the first. And over the years, the wear and tear could cause OA. The original joint will go through wear and tear, and the replacement may not be able to handle it as well and thus causes OA a lot earlier.
ReplyDeleteIt's true, most people are unaware of the link between ACl surgery and OA, as I was a part of that majority too. And using my friend as an example again, she has actually torn both ACLs and has only developed the arthritis and the pain in the most recently injured one. So even in her case, we can say that not all ACL injuries will turn into or cause OA. And everyone heals differently and recovers differently, which could explain why that football player that Curtis pointed out may have been able to return to his sport so soon and to his full potential. Although that alone could have been a mere result of the endless resources he was available to as a pro-athlete. I think the risk of developing OA comes down to the severity of the injury you had, how the surgeon fixed it as well as who the surgeon was, because all those things could be so variable. I was at a dog park-type thing this weekend and there was a lady there whose dog had gotten ACL surgery about a month ago. She went on and on to tell us that the surgeon who operated performed a new and improved technique that was almost completely non-invasive in that they use only needles to go in and repair the damage leaving even smaller incisions (if you can even call them that), and no scars. She even went on to say that this technique was so good and so effective that they were now doing it on humans. Having just written this post last week, I decided to search her claim and was unable to find such a procedure done on humans or on dogs...She wasn't exactly an expert in the field though.
ReplyDeleteI have a different yet similar example. Only mine is with my Achilles tendon. I did not get a replacement tendon from a donor but a synthetic tendon so that my body would not react negitively to the donor tendon. This happened 6 years ago along with a Talus injury. I have had 3 surgeries since then to clear out the arthrosis in the bone. I have yet for it to be called AO though so that is very interesting to me. With surgery you are also weakening the muscle groups next to the surgical site from non-use could this be a reason AO come into play?
ReplyDeleteOne thing that recent science has brought into play for these patients is Platelet-rich plasma (PRP). It is a procedure that allows a natural concentration growth factors. The possibility to use the patients’ own growth factors to enhance the repair process in tissues with low healing potential, such as a knee or ankle tendons,is increased. The preliminary clinical findings and the safety of these methods make it easier to use. The analysis of the results are contradictory for clinical findings for the treatment of sport injuries right now, but who knows what the future will hold.
On a slight side note. I did find out that instead of full knee or ankle replacement they can do a cadaver replacement. I wonder how that would work with different bone marrow and bone in you.
Nice blog.....If you are looking for ACL Surgery video on YouTube please check out http://www.youtube.com/watch?v=YA4p8QG8OG0
ReplyDeleteHow can I get relief from my back ache? Partial Knee Replacement in Delhi
ReplyDeleteACL surgery sometimes become so much important for some patients. Today many people suffer from hip or knee pain for various reasons. There's no doubt about it, arthritis can be one of the most painful and debilitating diseases in the world. more details here
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After ACL tear Surgery one should follow the instruction given by the doctor to recover from surgery. ACL tear
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