For knee injuries, surgery may not be the best option

For knee injuries, surgery may not be the best option

Research finds rehab-only treatment yields better long-term results

Adam Culvenor, La Trobe University

Knee reconstructions may lead to more problems later in life than non-surgical rehabilitation, researchers have found.

A team led by Dr Adam Culvenor from La Trobe University looked at health outcomes for athletes with damaged anterior cruciate ligaments (ACL) – a devastating injury, particularly common among footballers.

ACL injuries require lengthy rehabilitation and up to 12 months on the sidelines. However, many athletes also opt for surgery to reconstruct the torn ligament in the hope that this will get them back to sport sooner and prevent the development of knee arthritis.

To test the efficacy of this approach Dr Culvenor and colleagues from Lund University in Sweden and Paracelsus Medical University in Austria conducted analyses on a world-first clinical trial involving 117 ACL injured athletes.

The participants were either given surgical reconstruction within 10 weeks after the injury, or non-surgical rehabilitation with the option of having a reconstruction later in life. Their progress was then monitored for five years.

Magnetic resonance images (MRI) of the affected knee joints revealed that those who had undergone early surgery experienced a greater loss of kneecap cartilage – a key cause of arthritis.

“These findings challenge existing beliefs that reconstruction surgery is required to prevent early arthritis in young adults following ACL injury,” says Dr Culvenor.

“Indeed, early surgery was actually detrimental to knee joint health. We suggest that reconstruction surgery should not be used to prevent arthritis in young adults with an ACL injury. It may actually lead to more young people developing ‘old knees’.”

The research was recently published in the British Journal of Sports Medicine.

Further reading:

Culvenor AG, Eckstein FE, Wirth W, Lohmander LS, Frobell R. Loss of patellofemoral cartilage thickness over 5 years following ACL injury depends on the initial treatment strategy: results from the KANON trial. British Journal of Sports Medicine. 2019 doi:10.1136/bjsports-2018-100167

Image credit: Jack Moreh /

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