It seems like a right of passage. A young athlete blows out a knee ACL ligament and that event turns into a surgery to replace the ligament. However, what about ACL surgery arthritis? In other words, does operating on the ACL cause arthritis? After years of treating patients in their twenties and thirties with severely arthritic knees after a teenage ACL repair, it’s interesting to see recent research out of the American Orthopedic Society for Sports Medicine meeting that supports the concept that kids are getting arthritis after these surgeries.
The study data presented at the meeting suggests that teens who undergo anterior cruciate ligament (ACL) reconstruction may be at long-term increased risk for knee arthritis. The research group evaluated 29 patients aged 12 years to 16 years who underwent surgical reconstruction for ACL tears. At a mean follow-up of about 14 years, they found that the operated knees had significantly more arthritis compared to the other non-operated knee. Specifically, two thirds of the kids had arthritis in the ACL surgery knee by the time they were 26-30 years old. How did the other knee that wasn’t operated on fare? Only 14 percent had arthritis. Yikes!
Why would these young men and women be getting knee arthritis at such alarming rates? While it may come with the initial injury, my belief is that we have enough evidence that the surgically replaced ACL has few of the properties of a normal, healed ligament. In fact, it has much less position sense, the artificial reconstructed ACL is at a steeper angle than the original, the newly discovered ALL ligament remains lax and the knee remains unstable in rotation.
The upshot? This study supports what we see in the clinic. Teens that get knee ACL surgeries don’t fare well as they age. Their knees tend to frequently get arthritis by their late twenties. As a result, given that we routinely see MRI evidence of healing using a precise injection of stem cells into the damaged ligament fibers, we now only recommend surgery for patients who either fail this procedure or have an ACL tear that is not a candidate for the ACL stem cell procedure.