Study: Half of Knee Reconstructions Are Avoidable

Friday, 01 Feb 2013 11:51 AM

By Nick Tate

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More than half of all ACL knee-reconstruction surgeries performed each year are avoidable and could be replaced by physical therapy and rehabilitation alone, according to a new research out of Sweden.
 
Lund University researchers, reporting in the British Medical Journal, said the findings confirm the conclusions of a controversial 2010 study they conducted that found up to 60 percent of all anterior cruciate ligament (ACL) reconstructions could be avoided in favor of rehabilitation. Critics questioned the findings and suggested follow-up studies would overturn those results.
 
But the follow-up study reported by Lund researchers this week confirmed the earlier results, suggesting surgery often offers no benefit over physical therapy and rehabilitation in the long run in the prevention of sometimes-debilitating osteoarthritis or other problems.

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 "We have continued with our study and for the first time are able to present a five-year follow-up on the need for and results of ACL surgery as compared with physiotherapy,” said Richard Frobell, an associate professor at Lund and an orthopedic specialist at Helsingborg Hospital who helped conduct the research.
 
“The findings have been published in the British Medical Journal and are basically unchanged from 2010. This will no doubt surprise many people, as we have not seen any difference in the incidence of osteoarthritis.”
 
Frobell noted the research group's 2010 study, published in the New England Journal of Medicine, was challenged by some orthopedic clinicians who said more research was needed. For the follow-up study, Lund researchers tracked a group of patients who had reconstructive surgery after having knee problems and compared them to a similar group of individuals who underwent physical therapy without surgery.
 
After five years, the results showed virtually no difference in the risk of developing osteoarthritis or the need for meniscal surgery.
 
“Neither was there any difference in patients' experiences of function, activity level, quality of life, pain, symptoms or general health," said Frobell.
 
"The new report shows that there was no difference in any outcome between those who were operated on straight away, those who were operated on later and those who did not have an operation at all. The message to the medical experts who are treating young, active patients with ACL injuries is that it may be better to start by considering rehabilitation rather than operating straight away."

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