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ACL repair and osteoarthritis

Kristin Gunn • Sep 24, 2019

studies which rely on x-ray’s to confirm the presence of osteoarthritis are not the most meaningful test to evaluate outcome after ACL injury.

One of the reasons surgeons have historically advised anterior cruciate ligament (ACL) repair is the prevention of osteoarthritis (OA) in the knee joint. A recent publication reviewed all the research into this topic and found “The prevalence of symptomatic knee OA was 35% for the tibiofemoral joint and 15% for the patellofemoral joint more than 10 years after ACL injury.”

As I wrote about earlier this year knee osteoarthritis correlates with a reduced quality of life in the senior community. The presence of degenerative joint changes are not however directly related to pain and disability. With this in mind studies which rely on x-ray’s to confirm the presence of osteoarthritis are not the most meaningful test to evaluate outcome after ACL injury.

They identified risk factors for OA identified on X-ray at the tibiofemoral joint were increased age at surgery, additional injury eg damage to cartilage or bone, range of motion loss at final follow-up, partial medial meniscectomy and articular cartilage damage. For patellofemoral OA, the reported risk factors were increased age, tibiofemoral OA, impaired knee function, more symptoms, pain during activity and kneeling pain. The only consistent predictor of OA in all scenarios was the presence of a meniscectomy ie surgical removal of meniscus.

More importantly risk factors for symptomatic knee OA were reduced knee function 2 years postoperatively and loss of quadriceps strength between 2 and 10–15 years. This suggests that having good post-op rehabilitation and really keeping up with specific strengthening exercises in the long term can reduce the pain and disability of knee osteoarthritis.

OA prevalence >10 years post-ACL tear was not different in those treated surgically (8%–68%) compared with non-surgically (24%–80%), which indicates little difference in OA development between treatment options . The findings are in line with a randomised controlled trial study by Frobell et al who reported no difference between surgically and non-surgically treated participants at 5-year follow-up. This is confirmed by recent systematic reviews and meta-analyses. Studies have shown that ACL reconstruction is not a prophylactic treatment in the development of OA.

Other studies have identified additional factors

·Supervised exercise is more successful than home exercise

·Rehabilitation for nine months post ACL provides better outcomes that ceasing rehab earlier

·The other knee has an increased likelihood of OA- possibly from compensating for the injured side?

·There is a poor correlation between OA on x-ray and pain

·Maintaining good quads strength may be important in reducing pain and improving function

·Keeping a low body weight also helps

·Keeping active also helps

There are several important factors to weigh up when considering reconstruction after an ACL injury. The evidence is mounting that the presence or absence of osteoarthritis is not one of them. Good quality, prolonged rehabilitation is so if you have any questions give us a shout at Contact Physiotherapy, Methven Medical Centre 3028 205.

Lie MM, Risberg MA, Storheim K, et al What’s the rate of knee osteoarthritis 10 years after anterior cruciate ligament injury? An updated systematic review British Journal of Sports Medicine 2019;53:1162-1167

Contact Physio Latest News

By Kristin Gunn 18 Dec, 2019
Season’s Greetings from all of us at Contact Physiotherapy. Thank you to our staff, clients and the wonderful community of Methven for another inspiring year of health and learning. I am grateful every day to be a part of this hard working, dynamic community and wish you all a very Merry Christmas and a Happy, Healthy 2020!
The festive season is traditionally a time of indulgence so I thought it might be an opportunity to reflect on a few wellness behaviours that I have written about over the course of this year. We MAY employ them over Christmas or perhaps consider them for the New Year’s Resolution list!
• ACTIVITY! Take a walk, play tennis, have a bike ride. The single most consistent health recommendation for EVERY health prevention and management is exercise. Do something- anything and endeavour to make it a habit
• Drink equal amounts of water to alcohol- at least if you are over indulging you may stay hydrated
• Sleep- it can be such a busy time with so much travel or farm work- add in lots of parties and sleep can go by the wayside. Sleep is important for health, performance and to keep you safe in a vehicle
• Be grateful- there is increasing evidence that positive beliefs, time spent with friends and thankfulness helps back pain, cancer, tendon and shoulder pain. The business and financial strain of the festive season can detract from what really matters. Take pleasure in the little things and don’t sweat the small stuff. Your body will thank you!
One of my greatest pleasures this year was to catch up with the last five years of physio staff! These girls have brought so much pleasure to us, our clients and the little town. So festive greetings to Philene in Singapore; Isabel in Sydney, Australia; Katie and Lizzie in London, UK and Anna who is celebrating in the Falkland Islands!! Merry Christmas- love you girls! And a very special thanks and Happy Christmas to Amy, Jude and Tania. I am lucky to have such an amazing team.
By Kristin Gunn 16 Dec, 2019
Merry Christmas Everyone!
Contact physiotherapy’s last day is Friday 20th December this year and we will re-open on Thursday 8th January 2020.
Thank you for your continued support this year and here’s to a Happy Healthy 2020!
Kind regards Krissy, Amy and Jude
Contact Physiotherapy
By Kristin Gunn 10 Dec, 2019
I have written about osteoporosis and falls before, but maybe it is a timely reminder as we catch up with relatives we may not have seen for a while. About a third of women and a fifth of men will sustain a fracture due to bone thinning. Improving bone density can also provide a range of Christmas gifts you may never have considered?! Who knew?
First we prevent Osteoporosis while we are young. Make sure your children are taking enough calcium and performing impact and resistance exercise. While this advice remains the same throughout your life, we achieve maximum bone density by our late teens. Maybe a yoghurt making machine and a skipping rope? Thanks Santa!
On the family holiday, get into the hills and carry a pack- thus incorporating load and impact, family fun and maybe a love for the outdoors which will give a lifetime of health benefits. And a love of the outdoors will ensure the wish list for gear will never be filled!
Alcohol reduces balance and inhibits the uptake of calcium and therefor reduces bone density. So if you are looking at a quick gift maybe don’t just grab a bottle- try a healthy hamper with canned salmon, cheese and ice-cream or a punnet of grow your own greens like spinach, kale, rocket and broccoli. Take drinks like orange juice or milk with added calcium or home baking with almonds, sesame seeds and figs served with greek yoghurt.
To optimise bone density the load needs to be progressive to keep the improvement going. Optimally it should be the highest tolerable intensity, regardless of age. A membership and supervised gym programme by a qualified professional would be a great gift for a loved one- weights are beneficial at any age, even if they have sustained falls or an osteoporotic fracture. Lining up a gym buddy can help with attendance- can you talk a neighbour into it aswell?!
Public exercise is not for everyone. Small hand and leg weights will also help with strength and bone density. Gift these with a physio or qualified personal trainer appointment at home and encourage exercise in a loved one’s comfort zone.
Balance is critical for prevention of falls. Generalised strengthening and balance specific exercises are required. Assessing the environment is also important. It can be a sensitive subject though- maybe not one for Christmas Day! If you are visiting family, check for lose carpets or uneven steps. Pop a rail up in the bathroom or by steps. Repeated and sustained bending is a risk- can you help to reduce injury by raising the washing basket or wood pile? Or tidy out the cupboards and shift the soup pot from the back-corner cupboard. Long handled gardening equipment makes an excellent gift. Balance disc’s can be a fun motivating way to challenge balance and are easy to store away.
If you visit a relative and hear they are having falls there are falls prevention programmes available around New Zealand. Check them out at the local community or medical centre. In Methven your nurse, GP or physio can refer seniors to a free Falls Prevention Service in your home. Stay on Your Feet is a community led exercise programme in Methven- contact Age Concern on 308 6817. Tai Chi also helps balance, contact Margaret Lee on 027 516 7549. Research has shown that improving leg and core strength can reduce falls by 30%. Our Pilates classes can assist with that and we have clients 8-80 years old- call Contact Physiotherapy 3028 205.
So think about bone strength and all the members of your family now and give a gift of health for Christmas.
Reference: Expert Consensus Statement on Physical Activity and Exercise for Osteoporosis- Draft (2018) National Osteoporosis Society, UK
By Kristin Gunn 02 Dec, 2019
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By Kristin Gunn 23 Oct, 2019
It is with a heavy heart that we will be saying farewell to our lovely winter locum Anna Fenton in a couple of weeks. She has been a breath of fresh air in our clinic over the cold winter months. Her physio skills are awesome but it is her warm heart, good humour, hard work and harder play which have won her a place in Methven’s heart.
I am especially grateful to her and Tania Wright to have inspired me with some new and truly nasty Pilates exercises to torture you lucky people with over summer! After six classes last week I am feeling great- but please don’t make me laugh!!
Anna is off to Nelson for the summer- we hope she really enjoys herself but doesn’t have TOO good a time …???! Much more we hope she will come back next winter- there are still so many slopes to ski and mountains to climb and perhaps the full Peak to Pub next year?! She is, for sure “the stuff we need!” So if you get the opportunity please add to Anna’s list of things still do in Methven for 2020!
If you have another appointment to fit in with Anna before she goes, there is still time! Give us a ring at Contact Physio on 3028 205.
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