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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I'm 47-years old and in a bit of a bind. I reinjured my left knee while out hauling rocks for my garden. I haven't had any trouble with that old injury from years ago until now. I put off having surgery back then. I was young enough to rehab the ACL tear. But what about now?

Age may or may not be against you. It's natural to assume that the older you are, the less likely you will heal or recover quickly and completely. But, in fact, age may not be the main factor. That doesn't mean that the consequences of a repeat ACL tear aren't there. Studies show that unresolved ACL tears eventually go on to add damage to the medial meniscus. The meniscus is a tough, rubbery C-shaped piece of cartilage that acts like a shock absorber in the knee. It forms a gasket between the tibia (shinbone) and the femur (thighbone) to help spread out the forces that are transmitted across the joint. Walking puts up to two times your body weight on the joint. Running puts about eight times your body weight on the knee. Besides protecting the joint surface, the menisci (plural for meniscus) also help the ligaments stabilize the knee. In a recent study of ACL injuries, 31 patients with a chronically ACL-deficient knee delayed surgery for unknown reasons. Their surgeons took MRIs of the knee every six months after the injury. At the time of the initial injury, only half the group with an ACL tear had a meniscal tear. When the next MRI was done, only five of the 31 knees no longer had a medial meniscal tear. Not only that, but of the patients who did have a meniscal tear right from the start, almost half of them had a worse meniscal condition when the second MRI was done. The researchers involved in the study did a separate analysis to see if age or activity-level was a factor. It was not. The biggest determinant of additional injury to the meniscus was the delay in surgery past six months. Medial meniscal tears occurred more often the longer the patient delayed ACL reconstructive surgery. That begs the question: when it comes to protecting the status of the medial meniscus, is there an ideal time to have ACL surgery? Other researchers who have looked at this issue have concluded from their studies that reconstruction should take place between three and 12 months after the injury. And the results of this study not only confirm that conclusion but also offer the knowledge that the earlier the better. Delaying reconstruction surgery puts the medial meniscus at increased risk for tears. Treatment choices will be much clearer after you have had an orthopedic examination and consult. Some surgeons still want their patients to complete a pre-operative rehab program. This puts you in the optimum position to go into surgery with a strong leg, a potentially quicker recovery time, and faster progression through rehab.


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