Today's News

Friday, February 23, 1996

Rehabilitation helps older athletes who suffer ACL tears

Athletes over the age of 40 who have anterior cruciate ligament (ACL) reconstruction, followed by a year-long rehabilitation regimen, can expect to return to their previous athletic level and have a lower reinjury risk than patients who are treated nonoperatively according to a study presented Thursday in scientific paper 24.

Seventy-two patients (75 knees) who had ACL reconstruction were studied between August 1984 and May 1992. All athletic and between 40 and 60 years old, these patients' injuries resulted primarily from skiing, tennis, and soccer. Other injuries included basketball, football, hiking, jogging, racquetball, biking, gymnastics, and volleyball.

In this study 77 percent of the patients returned to their preinjury level; 20 percent felt it was necessary to modify their level of activity; and 3 percent no longer engaged in athletics due to their fear of reinjury.

Following surgery, patients were able to return to some activities within a year: biking, four months; jogging, nine months; skiing, 10 months; and tennis, 12 months.

Postoperative pain and swelling had been noted in only three knees, but no patient reported "giving way" or instability in their operated knees. Preo-perative pain and swelling had been reported in 80 percent of the knees; "giving way" was reported in 73 percent.

"The reinjury rate in our study after return to activity was 7 percent; compared to previous studies which showed a 35 to 37 percent reinjury rate in a group of nonoperatively treated middle- aged patients," said Kevin D. Plancher, MD, MS. He is assistant professor, Albert Einstein College of Medicine and attending orthopaedic surgeon, Montefiore Medical Center, both in the Bronx, N.Y., and serves as a consultant at the Steadman Hawkins Clinic, Vail, Colo.

Five patients reinjured their knees and required surgery. Fourteen patients required additional surgery after their ACL reconstruction, which included four for removal of painful hardware; one for patella tendinitis; and four for arthroscopic procedures for various limitations in motion of four degrees or less. Five of the 14 who had additional surgery had a second look arthroscopy for their chondroplasty.

None of the patients had any visible injury to their ACL graft; all had resolved their pain symptoms after their arthroscopic procedure.

Anti-inflammatory medicines were used by seven out of 72 patients, three who chose to use them during participation in sports. Four said they used the medications as a precaution but never experienced any swelling. Fifty-one patients continued to wear a brace for sports because of a fear of reinjury although they never experienced their knee giving way. Most patients used their brace an average of 16 months postoperatively.

The average time interval between the patients' injuries and surgeries was 45 months. Fourteen patients had acute injuries which occurred 21 days prior to surgery; 61 patients presented chronic ACL tears an average 238 weeks after their injury. Previous surgery (meniscus repair, meniscectomy, debridement, chondroplasty) was performed on 45 percent (34 knees) in this study. No patient had a previous ACL reconstruction.

All patients were operated on by co-author J. Richard Steadman, MD, founder and surgeon at the Steadman Hawkins Clinic, Vail, Colo., clinical professor at the University of Texas Southwestern Medical School, and director of the Medical Service for the U.S. Ski Team.

Data for this study was collected from subjective questionnaires from the Steadman Hawkins Sports Foundation. These forms evaluated symptoms, function, return to sports, daily living, and pain; functional results; and objective clinical data. All patients had an independent physical examination to reduce surgeon bias. Three knee rating scales (HSS, Lysholm, and IKDC) were used to analyze all patients. Patients' satisfaction with the surgery was rated at 100 percent, said Dr. Plancher.

Co-authors with Dr. Plancher and Dr. Steadman are Ken Taylor, MD, a resident at Albert Einstein College of Medicine; and Kirk S. Hutton, MD, clinical assistant professor, University of Nebraska Medical Center and orthopaedic sports medicine surgeon, Sports Medicine Center, Omaha, Neb.

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