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Two Knee Surgeries Are Not Necessarily Better Than One

Reconstruction of the anterior cruciate ligament (ACL) of the knee is a fairly common surgery. Sometimes patients, most often athletes, have torn the ACL in both knees. In these cases, it is not always clear how to proceed. Should the surgeon rebuild both ACLs in one surgery? Or should the surgeon do two surgeries at different times?

These authors compared the outcomes of 28 patients who had two separate ACL reconstruction surgeries (unilateral reconstruction) to 28 patients who had two ACL reconstructions at the same time (bilateral reconstruction). The average age of both groups was about 30. The authors followed them for two to five years after surgery. Both groups had the same type of surgery, and they all followed the same rehabilitation program.

The authors found no difference in the outcomes between the two groups. Patients were about equal in their ability to function and return to work and sports. Both groups regained strength in both legs. There was also no difference in pain after surgery. The group who had bilateral construction didn't use any more pain medication in the hospital than the unilateral group. This finding surprised the authors. They expected that a surgery that involved both legs would cause more pain.

There are benefits to doing both ACL reconstructions at the same time. Costs are lower because there is only one operating room fee, one hospital stay, and one period of rehabilitation. The patient only has to go through surgery and rehab once. This means less time away from jobs and activities. The authors conclude that bilateral ACL reconstruction is a safe, effective, and economical option for many patients.

References: Sanjiv Jari, BSc (Hons), MBChB, FRCS (Eng), FRCS (Tr & Orth), and K. Donald Shelbourne, MD. Simultaneous Bilateral Anterior Cruciate Ligament Reconstruction. In The American Journal of Sports Medicine. November/December 2002. Vol. 30. No. 6. Pp. 891-895.

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