Knee Surgery: An Update on Outcomes
By Nadine Salmon, BSN, IBCLC, Clinical Content Specialist AMN Healthcare
The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee. About 150,000 ACL injuries occur annually in the United States, and more than 4 million knee arthroscopies are performed worldwide each year (American Orthopedic Society for Sports Medicine, 2011).
According to the American Orthopedic Society for Sports Medicine (2011), arthroscopy is a common surgical procedure in which a joint is viewed using a small camera inserted into a tiny incision. Arthroscopy is a minimally invasive technique that allows access to the knee joint for visualization and repair. Technical advances have led to high definition monitors and high resolution cameras, making arthroscopy a very effective tool for treating knee problems.
Arthroscopy for the knee is most commonly used for the removal or repair of torn meniscal cartilage, reconstruction of a torn anterior cruciate ligament, trimming of torn pieces of articular cartilage, and removal of loose fragments of bone or cartilage or inflamed synovial tissue (American Academy of Orthopedic Surgeons [AAOS], 2011).
Recovery from knee arthroscopy is much faster than recovery from traditional open knee surgery. Possible complications of arthroscopy could include swelling, infection, blood clots and accumulation of blood in the knee. Typically, patients are able to drive from 1 to 3 weeks after the procedure, and most physical activities can be resumed 6 to 8 weeks after surgery, (in some cases, much sooner). High impact activities may need to be avoided for a longer time (AAOS, 2011). The final outcome of surgery will likely be determined by the degree of damage to the knee joint. If the articular cartilage has worn away completely, then full recovery may be less likely, and lifestyle modifications may be necessary.
Yet, despite the fact that arthroscopy and ACL repair is minimally invasive, an Australian study recently published in The American Journal of Sports Medicine indicated that 50% of those who underwent knee reconstruction, reported a decrease in performance post-surgery in both competitive and social sports. In fact, the report indicated that of more than 300 men and women who had knee reconstructive surgery, one third stopped playing sports entirely, while 68 participants who remained active said they didn't play as well as before surgery (Thrasybule, 2011).
In this study, researchers followed 314 men and women for two to seven years. Study participants had either played Australian-rules football, basketball, netball or soccer before their surgeries. At 39 months post-surgery, only 208 out of the 314 people who had an ACL repair were still playing a sport. Of those who continued to play, 68 said they played at a lower level than before their injury, and 140 said they played about the same as before their injury. The remaining 106 participants either were not playing sports or did not complete the entire study.
The researchers noted additional reasons participants chose to stop playing sports could include a fear of re-injury or decreased confidence in performing (Thrasybule, 2011).
American Academy of Orthopedic Surgeons (2011). Knee Arthroscopy. Retrieved from: http://orthoinfo.aaos.org/topic.cfm?topic=a00299
American Orthopedic Society for Sports Medicine (2011). Retrieved from: http://www.sportsmed.org/
National Institute of Health (2011). Knee Injuries and Disorders. Retrieved from: http://www.nlm.nih.gov/medlineplus/kneeinjuriesanddisorders.html
Thrasybule, L. (2011). After ACL repair, half can't play sports the same. Medline Plus. Retrieved from: http://www.nlm.nih.gov/medlineplus/news/fullstory_117542.html