Nearly a quarter of skiers that hit the slopes and tear their anterior cruciate ligament (ACL) can successfully recover without surgery, according to new research.
The study, conducted by researchers at the Hospital for Special Surgery in New York City, found that at six to 12 weeks after the ACL tear, two tests involving only a physical manipulation of the knee can identify skiers with torn ACL who can do without an operation as their ligament has healed by itself.
ACL tears from skiing are typically less traumatic than tears seen in football or other sports that involve pivoting. This is the first study to show that low-grade ACL tears from skiing can heal without an operation, said Dr Robert Marx, an orthopedic surgeon in the Sports Medicine and Shoulder Service at Hospital for Special Surgery, who led the study.
The results suggest that patients who tear their ACL during recreational skiing should wait and be re-evaluated at six to 12 weeks from injury instead of rushing to a schedule surgery, unless such intervention is necessary because of a displaced meniscal tear or other ligament injuries.
Dr Marx conducted the research after noticing that some of his patients with clearly torn ACL after a ski accident appeared to have healed ligaments at six to eight weeks.
To get hard data on this phenomenon, the researchers went through the records of patients treated by Dr Marx between 2003 and 2008 to identify skiers who were seen within six weeks of a first-time ACL tear. To be included, skiers had to have ACL tear documented on magnetic resonance imaging (MRI) after the injury and two or more years of follow-up. Patients with injured ligaments in both knees were excluded from the study. The researchers identified 63 acute, first-time ACL tears from skiing, with 29 of the cases resulting in no ACL surgery.
The 29 patients were then divided in two groups: those with low-grade Lachman scores and negative pivot shift tests, which is a sign of potentially healed ACL, and those with high Lachman scores of 2 and above and positive pivot shift tests indicating a damaged ACL.
Six to 12 weeks after injury, 17 of the 29 patients who did not have surgery had a Lachman score of 0 to 1 and a negative pivot shift test. Six of these patients were lost to follow-up, but 11 participated in a study-specific assessment at more than two years after the injury. Physical exams showed that 10 of the 11 patients still had low Lachman scores and negative pivot shifts tests, indicating a healed ACL. In 10 of the 11 patients, the knees were rock solid, as good or better than surgery. Moreover, the median age of the 11 patients was 43, an age at which recovery from an ACL operation could be more difficult because of reduced muscle mass. Identifying patients who can heal their ligaments without surgery at 12 weeks has significant benefits such as shorter recovery time and lower medical costs, Dr Marx concluded.