Lifestyle and not age a factor when deciding to operate on ACL

Link http://www.orthosupersite.com/view.asp?rID=25707

1st on the web (January 15, 2008)
January 2008

LAHAINA, Hawaii - ACL injuries accompanied by the ability to bear weight, almost full range of motion, slight effusion and no pain are prime candidates for surgery, according to an orthopedic sports medicine specialist.

"ACL surgery is rarely an emergency," John A. Bergfeld, MD, said. "It doesn't need to be done the next day."

He said that chronologic age is of little importance. Bergfeld's comments came during a presentation at the Orthopedics Today Hawaii 2008 meeting, here.

"It is the patient's lifestyle that is important," said Bergfeld, Sports Medicine Section Editor of Orthopedics Today.

A factor that illustrates when surgery is indicated is a third-degree ACL without a displaced meniscal tear.

"I wait until the patient can bear weight and has almost a full range of motion," Bergfeld said. He said he waits from 3 days to 3 weeks after injury to perform ACL injury surgery.

Early surgery is indicated when the knee motion is blocked by a torn meniscus or if the patient has an associated capsular ligament tear. These patients should undergo surgery in 7 to 10 days to ensure proper anatomic repair, he said.

Bergfeld said ACL repair surgery is not indicated if the patient cannot perform a leg raise, fails to make progress in regaining range of motion, is tentative to bear weight, has unresolved effusion, or is morbidly obese with multiple ligament injuries.

Operative decisions about in-season athletes with ACL injuries should be made based on the severity of the injury and the sport, he said.

"In general when an in-season athlete injures his or her ACL, I feel that their season is over and they should have surgery when it has settled down," Bergfeld said.

For more information:

Bergfeld, JA. ACL injury — When to — when not to operate. Presented at Orthopedics Today Hawaii 2008. Jan. 13-16, 2008. Lahaina, Maui, Hawaii.