People who suffer an ACL tear may be at increased risk for developing arthritis later.
For many people, especially athletes or highly-active individuals, the
fear of an injury to the anterior cruciate ligament (ACL) is very real.
You’ve likely seen an athlete on your favorite professional sports
team suffer an ACL tear and you (as well as all the sports reporters)
somberly come away with a number of questions. Will they be ok? Will they
need surgery? How long will it take for the injury to heal? When will
they be able to get back in the game? Will they ever perform at the same
elite level they did prior to the injury. These are common and important
questions. But one question that isn’t often on the mind when someone
tears an ACL is this – will they develop arthritis later in life?
I know it can be hard to imagine life beyond the playing field for athletes
or fans. But the fact of the matter is that we all get older, and the
injuries we sustain in our younger years can affect us later in life.
ACL tears are among those injuries that can have a lasting impact beyond
the sports or activity we love. Some studies suggest that athletes who
experience an ACL tear are more likely to develop knee joint arthritis
in the affected knee within ten years of the tear.
Arthritis is common, but most people don’t understand it well. You
may be surprised to learn that the term arthritis isn’t the name
for a singular disease but for more than 100 joint disease types that
fall under the infamous arthritis banner. Also, contrary to popular belief,
arthritis isn’t simply an “old person’s” disease.
While the risk of it does tend to increase as we age, there are childhood
forms of the condition and other types that can affect people of all ages,
genders, and racial backgrounds. Specific to the type of arthritis involved
when an ACL tear is a potential cause, we refer to posttraumatic osteoarthritis.
Posttraumatic osteoarthritis (PTOA) is the type of arthritis characterized
by wearing down of the protective joint tissue, called cartilage, at the
end of bones, following a traumatic injury to the involved joint. In one
large meta-analysis study of more than 4,000 patients who had suffered
an ACL tear, researchers determined that the prevalence of osteoarthritis
increased with time after ACL reconstruction. Interestingly, that prevalence
increased further if the time between the injury and surgery was longer
and when the patient was older. Another interesting finding was that the
risk of PTOA increased if the ACL tear was also accompanied by injury
to the meniscus or articular cartilage in the affected knee.
I know that no one wants to rush into surgery, especially when they’re
younger. But follow-up with an experienced orthopedic surgeon following
an ACL injury is crucial. If the damage is irreparable without surgery,
then it’s essential to find that out sooner rather than later. As
the referenced studies suggest, the longer one waits to repair a torn
ACL, the higher their risk might be of future joint conditions in the
affected knee – which can last a lifetime.
Of course, the best way to prevent knee arthritis associated with an ACL
tear is to avoid the ACL tear through proper training and conditioning
techniques. Thankfully, many more sports organizations are employing these
techniques today as part of their regular practice routines. One example
is the Prevent Injury and Enhance Performance or PEP Program. My esteemed
colleagues and I developed the PEP Program for a wide range of athletes
to increase their muscle strength, stamina, control, and balance –
all critical factors in preventing ACL injury. We found that one of the
most significant factors in ACL injury was catalyzed in the hip, not the
knee. Essentially, when hip muscles are weak, the load responsibility
is shifted to the knee, causing stress and fostering a ripe environment
for an ACL tear. To combat this phenomenon, the PEP team developed a specific
combination of plyometrics, stretching, and exercises to provide strength
for the hip, thereby relieving the knee from picking up the slack.
Though many athletes may feel invincible when they’re young, it is
an absolute tragedy to see an 18-year-old tear an ACL, only to develop
debilitating arthritis before their 30th birthday. It doesn’t have to be this way. Proper prevention techniques
are out there and should be employed by every youth, collegiate, professional
and recreational athlete, coach, and team. Yet, even with good prevention
techniques in place, ACL injuries do occur. When they do, finding a qualified
professional to assess and treat the injury – sooner rather than
later – is critical.
Sources:
https://journals.sagepub.com/doi/10.1177/0363546517730072
https://www.arthritis.org/health-wellness/about-arthritis/understanding-arthritis/what-is-arthritis
https://health.usnews.com/health-care/for-better/articles/2017-03-10/preventing-and-reducing-acl-injury-a-pep-talk-for-every-athlete