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Combatting Arthritis After an ACL Tear


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.


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