This article is more than 5 years old. Information may no longer be current.
Age, laxity and level of sport keys to selecting management for ACL injuries
Click Here to Manage Email Alerts
 Donald H. Johnson |
At Orthopedics Today Hawaii 2012, Donald H. Johnson, MD, FRCSC, discussed the timing for ACL reconstruction and indications for surgical or conservative treatment.
“There certainly is a role for conservative management,” Johnson said during his presentation. “In the older, less active patient with other associated injuries, I think that is probably worthwhile. But, you should undergo a vigorous strength-conditioning program. I am more and more convinced that this is the key to sending people back to sports.”
Johnson noted that Donald C. Fithian, MD, identified patient age, degree of laxity and level of sports participation as factors to consider when determining whether patients should undergo conservative or surgical treatment for ACL injuries. Johnson noted that a 45-year-old patient who plays tennis on weekends may not need surgical intervention for an ACL injury, but an 18-year-old college soccer player would be indicated for a reconstruction.
Johnson also presented his own case of a 35-year-old male recreational downhill skier who had positive Lachman and pivot shift tests. Pretreatment, the patient had 6 mm of side-to-side laxity using KT-1000 testing and sustained a high-grade medial collateral ligament (MCL) injury and proximal MCL tear. Johnson conservatively treated the patient with immobilization. After 6 weeks, the patient had 4 mm of side-to-side laxity. At 12 weeks, the skier showed a further reduction in laxity and he had full range of motion.
Johnson recommends conservative treatment for patients who play non-competitive recreational sports and allows them to return to play after an evaluation of muscle strength and performance on a single leg-hop test.
“The real controversy, what do you do with a 65-year-old guy who skis 55 days a year?” Johnson said. “He is mobile. I do not know the answer to that, but I would tend to reconstruct him just based on his activity level.”
Regarding the timing of surgery, Johnson noted that patients with a lack of extension should undergo MRI. If an ACL/MCL injury is present, Johnson operates early to repair the tibial avulsion and then repairs both ACL and MCL injuries together with an ACL reconstruction. If either the posterolateral or posteromedial corners are involved, he said orthopedists should perform an early reconstruction.
“Otherwise, let the MCL heal and then reconstruct the ACL when you have a pretty good range of motion,” Johnson said. – by Renee Blisard
References:
- Johnson DH. The acute ACL patient: Evaluation and indications for surgery vs. non-operative treatment. Presented at Orthopedics Today Hawaii 2012. Jan. 15-18. Wailea, Hawaii.
- Arden CL, Taylor N, Feller J, Webster K. Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2011; 20(10):41-48.
- Donald H. Johnson, MD, FRCSC, can be reached at Sports Medicine Clinic, Carleton University, 125 Colonel By, Ottawa, Ontario, Canada K1S5B6; 613-520-3510; email: donnie@carletonsportsmed.com.
- Disclosure: Johnson is a consultant for Arthrex and Piramal, and receives royalties from Elsevier, Lippincott and Wolters Kluwer.