Healthy knees are foundational to huge amounts of force.
ACL tears are the most common knee injury associated with athletics and physical activity. They often occur during landing, deceleration, twisting, cutting and changing direction on the playing field or during exercise. Ligaments have no circulato play, and ongoing impaired knee function throughout the course of life.
How ACL Tears Affect Quality of Life
Any type of injury can have a negative impact that interferes with movement and performance. That effect is amplified for athletes and physically active populations when they are no longer able to know if those who were ACL deficient (receiving ACL tear treatment without surgery) differed in QOL scores from those who had ACL reconstructive surgery.
The research team performed a meta-analysis of studies that reported on QOL of 473 patients who were ACL deficient, five years or longer post-injury. The Knee injury and Osteoarthritis Outcome Score QOL subscale (KOOS-QOL) was used as a survey instrument to those who had reconstructive knee surgery following an ACL rupture.
The study produced the following findings:
● Knee-related QOL was impaired five to 25 years after rupture, in both ACL-deficient and ACL-reconstructed subjects. ● Reported outcomes of QOL were similar in both the ACL-deficient and ACL-reconstructed groups. ● Long term knee-related QOL impairments persisted after an ACL rupture, whether subjects had reconstructive surgery, or whether they received ACL tear treatment without surgery. ● New strategies are called for in treating ACL tears with long term QOL in mind.
Implications for Treatment
The study’s authors noted that, in many cases, “Rehabilitation alone is an effective alternative to non-surgical alternatives for ACL tear recovery without surgery.
The authors made the following recommendations for treatment:
● Clinicians should educate patients with ACL ruptures about possible long-term QOL outcomes, and should dispel patient beliefs that surgery is a superior treatment that will prevent osteoarthritis later on. ● When discussing management options with patients, clinicians should inform them of similarities in long-term QOL between reconstructed and physical therapy-only patients.
Practitioners should bear in mind the long-term QOL of patients with an ACL tear, and devise treatment protocols that address both short term and long term QOL.
In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.
Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.
The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.
Dynamic ultrasonography examination demonstrating the full thickness tear and already occurring muscle atrophy due to misdiagnosis and not referring the patient to proper diagnostic workup
Demonstration of how very small muscle defect is made and revealed to be a complete tear with muscle contraction under diagnostic sonography (not possible with MRI)
Complete tear of rectus femoris with large hematoma (blood)
Separation of muscle ends due to tear elicited on dynamic sonography examination
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