Physio-Therapy As An Alternative To Torn Ligament Surgery


Here is some good news for weekend athletes enduring torn ligaments. Henceforth, never take a hasty decision to undergo a surgery for a general type of torn knee ligament.

The findings of a recent study undertaken on amateur athletes in Sweden, most of the soccer players, show that sportspersons who immediately received an ACL reconstruction (anterior cruciate ligament is a surgery to replace the ligament in the center of the knee) along with physical therapy did not experience more improvement compared to those who began with rehab (post-hospital care) and underwent the surgery later provided it was still necessary.

The findings of the study published recently in the latest edition of the New England Journal of Medicine states that less than half of the athletes with torn knee ligaments who opted for the rehab-first plan had to go for surgery in two years' time. According to Richard Frobell, an author of the study paper who is associated with the Lund University Hospital in Sweden, it appears that individuals starting only with the rehab program have a fine possibility of turning up with an equally good result compared to having an ACL surgery in the early stages. He further said that it may be surprised to learn that actually many people with ordinary ligament tear do not require any ACL reconstruction at all!

Frobell, however, emphasized that the study undertaken by them did not take into account professional athletes. According to him, most professional athletes generally opt for surgery with a view to get back into their game as quickly as possible. In fact, professional athletes are not known to be keen to wait and watch the impact of rehabilitation to treat their torn knee ligaments.

It may be noted here that as many as 200,000 people in the USA undergo surgery to replace the anterior cruciate ligament (ACL) that is vital for the firmness of the knee. In fact, most knee ligament tears occur in sports requiring physical contact, such as football and soccer. These games require the players to plant their feet on the ground and spin around them.

According to experts, doctors are already aware that all patients enduring an anterior cruciate ligament tear require a surgery for their knee restoration. In fact, sportspersons involved in jogging or cycling may usually be treated by means of a knee brace and rehabilitation. This view substantiates the findings of the research conducted by Frobell and his team on amateur Swedish athletes. Frobell is of the view that the same plan may also work for athletes who desire to get back to more laborious sports, such as soccer. He says that this is more true in the case of sporting events on the lesser aggressive levels.

Incidentally, although a number of patients enduring an injured anterior cruciate ligament (ACL) may survive fine even in the higher level games, it is virtually impossible for the doctors to precisely envisage which of the ACL patients would eventually become 'copers'. Even Frobell has acknowledged that the findings of their research do little to provide help in this regard.

Presently, doctors as well as patients determine if a patient actually requires a surgery for the torn knee ligament. Together, they taking into account several aspects, such as simply the type of physical activities the patient indents to pursue as well as the general condition of the knee. According to Dr. Bruce Levy, a surgeon at the Mayo Clinic, a decision to undertake an anterior cruciate ligament replacement surgery is made depending on these factors.

The surgery involving ACL replacement is basically an outpatient process that entails substituting the anterior cruciate ligament with a tissue taken from the patient itself or from a cadaver (dead body). The risks involved with an ACL replacement surgery include infection as well as stiffness of the knee that may necessitate further surgeries. The expenses for an ACL replacement surgery is around $10,000 or maybe more conditional on what kind of tissue - from the patient or a cadaver, is required for the operation.

The study conducted by Frobell and his colleagues concentrated on 121 amateur athletes in Sweden, who were in the age group of 18 years and 35 years. Most of the subjects of the study comprised soccer players, while the others played volleyball. All these amateur players were enduring fresh and total ACL splits. Among the total athletes participating in the research, around 50 per cent were at random recommended to undergo surgery instantly along with physical therapy. The remaining half of the athletes began with rehabilitation for the improvement of their knee condition. Frobell said that on an average, the athletes who began with rehab needed approximately 60 sessions - twice or thrice every week. In other words, the rehab process actually involved treatment for anything between five to seven months.

When examined after two years, the group of athletes who underwent surgery along with physical therapy and those who started with rehab demonstrated an equal measure of improvements in different things, including pain, their feat in sports as well as the interference of the operated knee with their routine lives. It is interesting to note that as many as 40 per cent of the athletes from both the groups had once again achieved their earlier level of sports intensity. This was established by measuring the stress of the sports activities on the operated knee. It was found that there was an equal measure of improvement of the knee condition among those who underwent the ACL replacement surgery as well as the group of athletes who started off with rehab first. In other words, the findings of the study showed that the results of the surgery were nothing better compared to the rehab program.

On the other hand, Mayo Clinic surgeon Dr. Bruce Levy has advised people to exercise some amount of prudence while deducing the findings of the study undertaken on the Swedish amateur athletes. Pointing to the fact that all the subjects of the study were monitored only for a period of two years, Dr. Levy said this makes it difficult to assess the long-term impacts or benefits of either of the two strategies adopted by the researchers in treating torn knee ligaments of the concerned athletes. He further pointed out that around 40 per cent of the group of athletes who started with rehab eventually had to undergo ACL replacement surgery within two years and said that it was likely that more of them will follow sooner or later.

Meanwhile, Dr. Kurt Spindler, who is associated with the Vanderbilt University, pointed out that the group of athletes who started off with the rehab program in the study had problems with the meniscus (a cartilage disk that functions as a cushion between the ends of bones that meet in a joint). According to Dr. Spindler, this problem could sooner or later increase the hazards of developing osteoarthritis (the most common type of arthritis distinguished by chronic breakdown of cartilage in the joints resulting in pain, stiffness and swelling).

Taking a cue from Dr. Levy and Dr. Spindler's observations, Frobell has stated that the scientists would undertake further studies on this topic to examine the consequences of adopting the rehab program for torn knee ligaments over a period of five years. In addition, they also intend to monitor the developments in such patients and try to find if there are any early signs of arthritis by making use of X-rays and other medical imaging procedures.


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