A report issued last month from New York’s Hospital for Special Surgery merely confirms what we all knew: that ACL reconstructive surgery has reached an optimum level of patient satisfaction. The study involved over 230 patients – all of whom are active athletes – who underwent ACL reconstructive surgery and the results were a resounding endorsement of the treatment, with 98% of patients claiming that they were ‘highly satisfied’ with the procedure and they would happily undergo it again if they needed to.
The study set out to investigate rates and predictors of return to play, evaluate patient satisfaction after ACL reconstruction surgery, and analyse the relationship between the ability to return to their chosen sport – basketball, football, lacrosse, skiing, American football and tennis – and overall patient satisfaction. The 232 patients involved were on average in their mid-twenties, and an attempt was made to create an even gender split, with 52% of the study group being male.
ACL reconstruction – it needn’t be hell
All study participants had a minimum two-year follow-up after surgery, and were invited to partake in a questionnaire that asked about return to play, sport performance, repeat injury, factors influencing ability or inability to resume a sport, and overall patient satisfaction. The results were fascinating: 201 of the participants surveyed claimed that they had returned to playing their chosen sport at a mean time of ten months and 89% of those claimed that they had returned to their previous level of competition.
Obviously, results varied from sport to sport. The tennis players recorded the highest level of success, with a 100% return to participation: meanwhile, the football and lacrosse players recorded the lowest levels of success. Among those who didn’t make it back to peak performance, the most common reasons appeared to be more psychological than physical: fears about re-injuring the knee or being unable to ‘trust’ the reconstructed knee were a constant factor.
How the ACL works
Located from the back of the femur and running diagonally through the centre of the knee to the front of the tibia, the anterior cruciate ligament is a crucial component in maintaining joint stability. Simply put, the ACL stops your knee from rotating too much and helps keep the shin in place. It can be torn over time by repetitive turning and changing direction: it can also be instantly damaged by any violent impact on the knee.
The symptoms of an ACL tear include mild to severe instability, painful swelling and a long layoff from playing and exercising. Surgery isn’t always a given: ACL tears tend to be treated on a case-by-case basis, and there’s a school of thought that claims that a period of highly structured rehabilitation can repair the damage without surgery. However, in the world of professional sport, those rules don’t necessarily apply: ACL reconstruction surgery (using a strip of the patella tendon as a replacement graft) can get an injured participant back to full fitness in less than six months, if all goes well.
As the study bears out, ACL reconstructive surgery has come on in leaps and bounds: far from being a career-ending situation, the procedure has become an enforced time-out for athletes that could even prolong their careers in the long run – and it seems that the next step is to educate and reassure certain athletes to put greater trust in the procedure.