It's been over three years since we last talked about skiing and snowboarding ACL injuries with top consultant orthopaedic surgeon, James Lewis. So what has changed and what is the prognosis for skiers and snowboarders with knee pain and injury including knee replacements?
What are the most significant advances in surgery and treatments for ACL injuries in the past three years?
As always medicine advances in leaps. The biggest are an increasing interest and availability of repair - this is stitching the torn cruciate ligament back, and supporting it while it heals. This is repair, rather than the common removal of torn ends and substitution.
We have a greater understanding of which sub-types this works best for - ideally when the anterior cruciate ligament has torn of the femur (thigh bone) rather than in the middle of the ligament. The key advantage is a much quicker recovery, there is nothing removed and seemingly better results - in part because the original stretch receptors are retained. Additional no 'graft' is required (taken) from elsewhere.
The second is a widespread adoption of a lateral extra-articular tenodesis - this takes an extra 10 minutes and uses part of the iliotibial band. It functions a little like a seat belt in that if the newly reconstructed knee is about to rotate leading to re-rupture it prevents the excursion. Simply put it reduces the risk of re-rupture from about 6-7 percent down to 1 percent.
My own observations are that patients seem to have a better outcome with no stretching of the new ACL graft. The downside is the early recovery is a little slower - as there is more surgery initially.
How long between injury and surgery, on average?
In general by the time one has had an MRI, consultation and allowed the soft tissues to settle, six weeks is ideal.
Are ACL replacements still available for over 60s?
Indeed, though uncommon, but they still 'work' in the over 60s.
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