Dr. DeLee talks about the "7" A's used to decide who needs ACL surgery
When one has an acute injury to their knee and tears their anterior
cruciate ligament, the decision of whether or not surgery is indicated
involves profiling the patient. Such profiling is done in an attempt to
determine which patient is likely to develop functional instability of
their knee as a result of the ACL tear. Functional instability means
that the knee will give way or "slip out" and swell. Repeated episodes
of instability will result in further damage to the knee and produce
arthritis. Use the following seven (7) A's in making the decision
regarding whether or not surgery would be the best for one who tears
their anterior cruciate ligament.
- ACTIVITY LEVEL
The more active
one is the more likely they are going to need the stability of the knee
provided by the anterior cruciate ligament. This is particularly true
in two situations.
- If one is involved in a sport or activity that requires jumping, cutting, or twisting.
- If one is going to return to the same activity that caused them to tear their anterior cruciate ligament.
- AGE
Age in most cases is
related to activity level. For the most part, the younger one is the
more active they are likely to be. Certainly, there are some young
people who are couch potatoes and older people who are very active. If
one lives or plans to live an active life involving sports, then they
will likely need the stability to their knee provided by the anterior
cruciate ligament.
- AMOUNT OF LOOSENESS OF THE KNEE
Not
everyone who tears their anterior cruciate ligament has a lot of
looseness of their knee on clinical examination. For the most part, we
can say that if the knee has a lot of looseness in it after one tears
their anterior cruciate ligament then the more likely they are to have
recurrent giving way episodes.
- ASSOCIATED INJURIES
When one tears their anterior cruciate ligament there is a chance of having an injury to one of the following structures:
- One or both menisci
- Other ligaments
- The joint surfaces
(see arthritis in #5)
- ARTHRITIS
If one tears
their anterior cruciate ligament and has injuries to other structures
in the knee, there is a high probability that they will develop
significant arthritic changes in the knee. In addition, recurrent
giving way episodes when the knee slips out and swells, will likely
result in arthritic changes.
- ATTITUDE
The patient's
attitude is crucial to a successful ACL surgery. It is very important
for one to rehabilitate their knee and let the body's reaction to the
injury settle down. By allowing the reaction to the injury resolve
there is less chance of stiffness after the surgery. In addition, if
one will not rehabilitate before surgery it is highly unlikely that
they will do so after surgery.
- AIN'T NORMAL
The patient's expectations following ACL reconstruction is important.
I
apologize for using the word ain't, but it fits the ACL decision making
process.
Knees have special nerves in their ligaments that are damaged when one
tears the anterior cruciate ligament. When the surgery is done to
reconstruct your ligament, these nerves never fully recover their
function completely. Also, the surgery that is done uses a ligament
graft that is not exactly the same as your original ligament. For these
two reasons, your knee will never be exactly what you had before you
tore your ligament.
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