Study: Knee shape may identify good ACL surgery candidates


July 29, 2013

Topic: orthopaedic surgeons

Presenters at the American Orthopaedic Society for Sports Medicine Annual Meeting reported on the positive outcomes that followed meniscal repair.

Anterior cruciate ligament tears are a great fear for many athletes who rely on the strength and functionality of their knees. Although these injuries can keep players off the field for a season, orthopaedic surgeons and other specialists have come a long way to help patients get back into the game.

Needless to say, ACL injuries do not necessarily mean that an athlete's career is over. 

Improving treatment for ACL tears
New orthopaedic research published in the journal Proceedings of the Institution of Mechanical Engineering brings to light more information for specialists who work with individuals who suffer ACL injuries. In particular, the study focuses on knee shape and how it may determine whether a patient would make a good candidate for reconstruction surgery. 

In the U.S., orthopaedic surgeons perform approximately 100,000 ACL reconstruction operations every year, according to the American Academy of Orthopaedic Surgeons. However, surgery is not the only option. 

Healthcare providers may recommend that affected individuals treat their ACL injuries with non-surgical treatment. This typically consists of progressive physical therapy and rehabilitation. However, it is up to the surgeon to make the final call for what treatment route to follow, and the study's findings can help them do just that. 

Knee shape may make a difference
Researchers looked at nine cadaveric knees and specifically assessed the shape of the affected knee. The knees were mounted on a cycling machine that mimicked walking. They studied the mechanics of the knees with the ACL intact, and then with the ACL cut. 

"We thought that if we tested all of these knees, we would see very consistent changes in contact stresses. We would see some areas of the knee that saw a much higher contact stress than they had before we cut the ACL, and we would see other areas that would see a lower load," said Suzanne Maher, M.D. "What we found instead was that the change in contact stresses were highly variable. The only consistent finding we had was in the back (posterior side) of the knee; all knees had increased contact stress in the posterior central aspect of the knee, at 45 percent of the gait cycle."

Besides higher stresses on the posterior part of the tibial plateau, some knees also exhibited increased stress on the anterior part. These observations in particular are key, as they indicate that the shape of the knee may impact the severity of an ACL tear. 

Although this study was limited because the researchers used a small sample size, cadavers and only looked at walking, it brings to light the opportunity for further research that can improve the outcome of ACL reconstruction surgery. 


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