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ACL Injury: US Specialists Recommend Surgery Within Five Months

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A tear of the anterior cruciate ligament (ACL) in the knee can occur during a twisting movement in various sports, including netball, football, rugby, skiing and snowboarding.

Before deciding on the best course of action, a knee specialist will carry out tests to find out how much damage has been done. Special exercises can be done to strengthen the knee, and in some cases surgery will be advised.

For patients who are candidates for surgery, when is the best time for the procedure?

The American Academy of Orthopedic Surgeons (AAOS) recently released new evidence-based practice guidelines which recommend that reconstructive surgery should be performed within five months of an ACL injury to protect the knee joint.

Studies show that early ACL reconstruction (within 3-5 months from injury), when compared with later surgery, improved objective knee stability as measured by the Lachman test and pivot shift test. Three studies demonstrated a higher activity level in patients that underwent early ACL reconstruction, and one study reported higher function in this patient group.

Early reconstruction was also found to decrease the incidence of meniscus tears from 62% to 37% and to lower the incidence of subsequent meniscectomy surgery from 44% to 8%.

“In an active patient, if you wait too long to surgically repair the ACL, there is a risk for additional injury to the knee,” commented Kevin Shea, MD, chair of the AAOS Clinical Practice Guideline on the Management of ACL Injuries work group.

The AAOS stated that its recommendation was based on improving patient function and protecting the knee with ACL injury from further meniscus injury, which could reduce the risk for premature osteoarthritis.