I have ACL. Should I have surgery

Q: I'm having trouble deciding about whether to have knee surgery. I'm only 18 but I have an ACL tear. So I have two options: surgery right away before anything gets worse or rehab and wait to see if surgery is really needed. If it is necessary to have surgery, I can do it later but at a risk of reinjury in the meantime. What should I do?

A: You have a very clear understanding of the typical options offered young athletes with an anterior cruciate ligament (ACL) injury. There are pros and cons to both treatment choices. But some information from a recent (large) study at Kaiser Permanente might help.

Kaiser Permanente is a large health care facility located across the United States in 35 medical centers and 431 medical offices. They serve more than 8.8 million members. They have a special registry for ACL patients called the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry. The information in this large database was used for this study. They included 1252 patients from three different locations under the care of 20 surgeons.

The information for each patient treated surgically to reconstruct a ruptured ACL was placed into the computer database. Information included patient demographics (age, occupation, sex, date-of-injury, date-of-surgery). The record for each patient also included type of soft tissue injury and results of surgical repair (repair rates).

By running various computer statistical programs, the authors were able to analyze and evaluate all 1252 patients. They found that delaying surgery (12 months or more) was linked to a greater risk of medial meniscus and joint cartilage injury. The delay was also likely to result in a reduced repair rate. The results of this Kaiser study are very similar to other smaller studies that showed a delay in time-to-surgery was linked with poorer outcomes.

This Kaiser study took a look at more than just time-to-surgery by comparing age and sex as additional possible risk factors for greater injury and decreased repair rates. What else did they find here? Younger patients were more likely to just suffer an ACL tear without other soft tissue injuries. Females made up more of the younger age group than males. Men tend to participate in active sports longer so injure themselves across a broader range of ages.

With this information in mind, talk with your orthopedic surgeon. Find out what (if any) risk factors you may have should you decide to delay surgery. Ask about a timeline (i.e., if you wait to have surgery, how long can you delay the decision)? Ask your surgeon for any activity guidelines to follow during this decision-making process. This may help prevent meniscal and cartilage lesions while you choose the right treatment approach for you.

Reference: Ankur M. Chhadia, MD, et al. Are Meniscus and Cartilage Injuries Related to Time to Anterior Cruciate Ligament Reconstruction? In The American Journal of Sports Medicine. September 2011. Vol. 39. No. 9. Pp. 1894-1899.

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