Knee Surgeries to Correct On-the-Job Injuries Show Good Results
Jan. 25, 2000 (New York) -- Previous studies had shown that patients who
have surgery of the shoulder and spine due to an injury on the job tend to fare
worse than other people having these surgeries. Attempting to shed light on
whether this is also true for knee surgery, a new study suggests that patients
who undergo reconstruction of their anterior cruciate ligament (ACL) did just
as well as patients undergoing the procedure for sports injuries.
Yet while the study authors contend that their findings lend support to
recommending the procedure for many workers' compensation cases, an expert
questions whether the study supports that recommendation.
In a study published in the current issue of Arthroscopy: The Journal of
Arthroscopic and Related Surgery, researchers analyze outcomes of ACL
reconstruction procedures performed by Bernard J. Bach Jr., MD, from the
division of orthopaedic surgery and sports medicine at Rush-Presbyterian-St.
Luke's Medical Center in Chicago. The ACL is the ligament that holds the knee
together and helps stabilize it.
Studying 22 patients on workers' compensation, the investigators show that a
large proportion of these individuals had good outcomes. They compared the
results with those obtained from patients seen over time, finding just about
the same outcomes in terms of symptom relief, knee stability, and quality of
life. They argue that the data support recommending the surgery for patients on
workers' compensation who have this sort of knee injury.
However, another orthopedist disagrees. Robert B. Keller, MD, an orthopaedic
surgeon and executive director of the Maine Medical Assessment Foundation,
tells WebMD that it is quite a leap to conclude that this study should be taken
as a recommendation for surgery. "When patients are diagnosed with an
anterior cruciate ligament injury, they need to know that there are
options," he says. "Not every ACL tear requires surgery."
Keller says that there are age thresholds associated with the procedure. In
many cases, he says, "patients over age 40 or 50 are not considered good
candidates -- often because they don't work their knees that hard." Even
so, he is quick to point out that ACL reconstruction is a good operation and
that the surgery has improved in the past several years to permit a much faster
An important limitation of this study is that it includes results obtained
by only one surgeon, so it is difficult to generalize these results. Better
information would come from "larger studies with multiple surgeons and
reasonable controls," Keller says. Also, patients in the study were asked
to think back to how their knee felt some four or nine years ago. When doctors
ask questions that way, he says, the answers are not necessarily reliable.
In considering the surgery, Keller says, "patients need to get a lot of
information, including the risks and benefits."
- The anterior cruciate ligament, or ACL, is the ligament that holds the knee
together and helps stabilize it.
- According to a small study, patients who injure themselves on the job fare
just as well as athletes when undergoing surgery to reconstruct the ACL.
- Not every ACL tear requires surgery, and there are other options for