How frequently does knee ACL surgery failure occur? The number of ACL surgeries in young people, especially in young female soccer players, is exploding. These kids are often treated like professional athletes trying to eek out a multi-million dollar contract extension. However, is this a good idea? A new study shows that despite the huge surgery and big recovery time, an alarmingly high percentage of these kids rupture either their new ACL graft or the other knee. What gives?
The research out of Austrailia looked at more than 500 patients who tore their knee ACL ligaments and had them surgically replaced. A little less than 2 years later, almost 1/3 of the patients younger than 20 years old had ruptured the ACL graft or torn the ACL of the other knee. If these patients had returned to cutting edge sports, they were 4-5X as likely to rupture either ACL.
Why is this happening? As I’ve discussed, research has shown that problems with knee control on landing leads to a higher likelihood of ACL injury. I suspect that in our surgical “quick fix” society, many patients and their doctors never focus on why the ligament ruptured in the first place are not correcting those bad biomechanics. A recent study in dancers showed that in women, these risk factors can be corrected with extensive training on how to land. In addition, since the ACL grafts are not like the original equipment, they are unable to fully stabilize the knee and as such are more susceptibe to injury.
The upshot? ACL graft surgery in young athletes isn’t really working as planned. First, consider biologic injections to try to heal the ACL tear before having it surgically removed. Second, if you or your child needs ACL surgery, make sure the biomechanical problems that lead to the issue get solved before they return to sports! Finally, with other studies showing that the majority of these kids who get ACL surgery will get arthritis by age 30, you have to wonder about the wisdom of this aggressive surgery.