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Think twice before knee surgery

26 March, 2012

A La Trobe University study has shown that after knee reconstruction surgery, around 40 per cent of people do not return to their previous level of sports participation.

As time goes on, the number of people actively participating in sport as they did before being injured drops below 50 per cent by up to seven years after surgery.

PhD student Clare Ardern, who led the investigation from La Trobe University’s Musculoskeletal Research Centre, followed over 300 people from two to seven years. Participants had either played Australian Rules football, basketball, netball or soccer before surgery.

She says that while most people after surgery get back to playing some kind of sport, only around 60 per cent returned to playing at their pre-injury level, and athletes aged 32 and over were less likely to continue taking part in sport.

‘This is a surprise because as a physiotherapist I would expect that previously fit, active and healthy athletes to return to playing their sport at a similar level to before they were injured. It suggests there may be other factors influencing the decision to return to sport.’

With the 2012 footy season about to begin, Clare Ardern cautions that Aussie Rules footballers are at particular risk for injuries to the anterior cruciate ligament (ACL) because of the twisting, turning and pivoting moves. The ACL is the ligament inside the knee that keeps the joint stable.

She says that to minimise knee injury, footy players and other athletes should undergo targeted strength and neuromuscular control training programs to help control their knee movement and minimise the risk of injury.

She said the study’s findings were important for athletes considering knee reconstruction surgery.

‘Knee repair is big surgery and many athletes who choose surgery face a long road to recovery.’

‘Injured athletes and their medical team need to know how likely it is that they will be able to return to their sport if they have surgery so that they can make a decision about whether having surgery is the right treatment option for them.

‘Some people find that they are able to function well without surgery, provided they have adequate leg strength to support the injured knee. Typically these are people who don’t return to sport, or only return to low impact activities such as cycling, running and swimming. Other alternatives for people who do not wish to have surgery might be to avoid high impact sports such as Aussie Rules and netball, and to use a knee brace,’ says Ardern.

‘Knee surgery does allow people to go back to their sport but does not guarantee that they will return to their previous sports level,’ she adds.

Return-to-Sport Outcomes at 2 to 7 Years After Anterior Cruciate Ligament Reconstruction Surgery was published in the American Journal of Sports Medicine.

Source: La Trobe University

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bruni brewin | Tuesday, March 27, 2012, 1:20 PM
If we look at the mind-body connection, there is research that outlines both the placebo and nocebo effect. For example, in some people when the original injury occurs, imaging shows how the brain reacts to that happening, but it also shows that some people who have totally rehabilitated with everything healed, the brain still shows the original reaction and still feels pain. I would imagine in this instance, it would also put something into place so as to not do further damage. Whilst another research shows that some people who have undergone a research where as a control only a 'mock' operation on their knee where they viewed in half sedation on a monitor a real knee operation, the surgeon using the appropriate wording as though he was actually doing this operation - yet did nothing whatsoever other than a couple of skin nicks on the knee where the surgeons tools would have entered. Some of these people no longer felt pain after the mock surgery. (Followed up to 4 years later with the same pain free results.) It shows the importance of the mind/body connection and the relevance of the placebo effect.