Choosing a Knee Operation or Not? What You Knee(d) to Know
Greetings!
It has certainly been a while since I have posted. Today, I will cover having a knee operation (and non-operations) for acute knee injuries. The demography of Australia reflects an ageing population with a slowing birth-rate. This places the entire healthcare system under a growing weight of under-resourced and under-staffed.
For Australians to seek a healthy aging process into their golden years and beyond, a lot needs to change. The beyond is the key – the life expectancy has risen to 81.3 years for a male and 85.3 years for a female (read more) . Whilst the preventative vs curative health model is certainly skewed in favour of the latter, I believe it is time that some ownership of our health outcomes relates back to an individual’s accountability. I will digress further on this point later…
Sam Kerr: Knee operation
So what can be done from an evidence-based, pragmatic and long-term management plan for our acute knee injuries? With the honourable (wink) Sam Kerr in the headlines lately….. for her ACL repair(!), I thought it would be prudent to cover the latest research and where the dreaded ACL injury paradigms sits on rehabilitation. I was recently invited into a symposium workshop covering the acute sporting knee injury.
The Revolutionary Procedure that Could Salvage Sam Kerr’s Olympic Dream
Women’s soccer has never seen more players at all levels within Australia which begins at the grassroots level.
Furthermore, the Matilda’s hugely successful home world cup campaign in 2023, which garnered a mighty semi-final finish, enthralled the nation. Overseas, the WSL in England are having sell-outs galore with Arsenal’s women’s team continually selling out the Emirates stadium.
Incidence of Acute Knee Injury and Knee Operation
Whilst I believe and know this is great for the game, the injury side of things is becoming hugely problematic. Every year in Australia, more than 20, 000 people rupture their ACL! At the moment, roughly 90% of these cases undergo a reconstruction. This massive imbalance is placing huge strain on the health system. This is irrespective of whether a patient opts to choose between a private or public operation.
When investigating some of the data within Australia, I came across some rules regarding an acute knee injury in Sweden. If you are not a part of a sporting professional organisation, then you are not eligible for any scan of your knee for 3 months! The explanation behind this is that rehabilitation starts on day 1 – go and see your Physiotherapist and begin stabilising that knee! We have a long way to go in this nation to become a world leader like this.
The Process After You’ve Injured Your Knee
Generally speaking here, with regards to the process, if someone has suffered an acute knee injury, they will likely go the GP or Physiotherapist. From here, an MRI is ordered to rule in/rule out a certain diagnosis. Following this, consultation with an orthopaedic surgeon is usually required if the scan shows significant structural damage. Ongoing pre-habilitation is required with a Physio as well as an Exercise Physiologist. Onwards to this, if a knee operation is the preferred choice, then hospital bills/surgeon fees/anaesthetic costs/ongoing rehabilitation/time of work/likely NSAIDs all need to be factored in. The list goes on.
Unfortunately, females have a higher incidence of an acute ACL tear of their male counterparts. The reasoning is seen here through this excellent headline via ABC news:
I have also written about it previously:
Physiotherapy Vs Knee Operation
Diving deeper into the Physiotherapy realm here, the guidance offered here is invaluable. Generally speaking, if it a complex knee injury and suspected of Anterior Cruciate Ligament damage PLUS other structures – such as meniscus; medical/lateral/posterior collateral ligament; patella tendon – then imaging is a good idea. An unstable knee usually lends itself to a supportive brace of some description in order for a person to walk! Therefore, early consultation with your Physiotherapist to work with you to optimise the early part of rehab is critical.
Furthermore, an early intervention program of mobilising the calf and ankle is crucial to maintain muscle mass at this stage – you are certainly going to be asking a lot of the other joint in the lower limb to share the burden over the next few months. Discussing pain relief (with the assistance of your GP), RICE principles and suitable duties at work are also included in the initial consultation.
The Cross-Bracing Protocol: The Non-Operative Approach
Whilst still preliminary in nature, the results have been highly successful of people from all walks of life. Time is the crucial feature here – bracing should commence between day 5 and 10 post injury. This is to hopefully allow some swelling to dissipate. The optimal goal at this point is for the two ends of the ligament to be brought closer together to give it the best chance to re-attach! The best position to optimise healing is at 90 degrees flexion (think sitting in an office chair). A range of movement brace that can “lock the degrees” of bend is used for this. 6-10 weeks (depending on the precise injury) is encouraged. Then the brace is slowly “unlocked” to eventual straightening over the next few weeks.
Blood thinners are recommended in the initial phase to decrease the risk of deep vein thrombosis. From here, a progressive strengthening regime with your Physiotherapist is undertaken over the next period of time. Read more
So What Does This All Mean?
Start with a consultation with your trusted Physiotherapist. The guidance here at Sport and Spinal Physiotherapy is crucial to a successful return to sport. In late 2019 I ruptured my ACL playing touch football. I was able to successfully avoid surgery through consulting with my Physio, developing a highly specific gym program (I think I counted over 10, 000 single-leg leg presses) and I have no issues with my knee whatsoever. It can be done!
