June 13, 1996
Media Contact: John Cramer
Phone: (410) 955-1534

A patient's physical activities and the extent of microscopic structural damage are key factors in deciding whether surgery is needed to repair a major ligament in the knee, a study involving Johns Hopkins suggests. The findings indicate that only certain patients, mainly young athletes in high-risk sports, may need surgical reconstruction, while physical therapy may be best for most others.

"Surgeons and their patients should consider these factors carefully before deciding on a treatment," says Leigh Ann Curl, M.D., lead author and an assistant professor of orthopedic surgery.

Just as an old rope may snap due to unseen damage to its fibers, an anterior cruciate ligament that has been partially torn may have additional microscopic damage that over time will cause the ligament to fail completely under stress, so it may be best to consider reconstructive surgery at the time the knee is injured in some patients, says Curl. But, she cautions, the patient's age and type and level of activities also are key factors: for example, surgery may be best for an 18-year-old football player but unnecessary for a 40-year-old who walks, swims or rides a bike to stay in shape.

Results of the study will be presented June 20 at the annual meeting of the American Orthopedic Society for Sports Medicine in Lake Buena Vista, Fla.

Researchers studied 53 patients between 1985 and 1994 who elected not to undergo reconstructive surgery after an arthroscopic examination revealed a partially torn anterior cruciate ligament. One to five years later, the patients had their knees tested for strength, flexibility and agility, underwent X-rays and completed questionnaires on how well their knees functioned. Researchers looked at various aspects of the injury, including how much and where the ligament was torn, how the tear occurred, the surrounding damage and previous injuries and surgery on the knee.

The results suggest that the percentage of tear was linked to how well the knee recovered -- the worse the tear, the worse the recovery -- and that cases where half or more of the ligament was torn had the worst recovery. The results suggest that reconstructive surgery potentially is the best treatment for tears of 50 percent or more for people whose knees are exposed to twisting stress in sports such as soccer and football.

"The question is should reconstructive surgery be done when partial tearing is visible, and our findings suggest the answer is yes in certain patients," says Curl. "The ligament may look like a significant amount is intact and functional, but the remaining segment could be structurally and microscopically damaged. Most older people, however, and even younger people who don't participate in high-risk activities may not need surgery even in these cases."

Surgical reconstruction for torn anterior cruciate ligaments is common in some professional and collegiate sports and has been shown to restore much of an injured knee's strength and stability. Non-surgical options such as physical therapy, knee braces and eliminating activities that expose the knee to stressful maneuvers also have proved effective for non-athletes. Ligaments are tough, fibrous bands of tissue that bind bone ends together.

The Hospital for Special Surgery in New York City funded the study.

-- JHMI --
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