July 01, 2010
Arthritis Inevitable After Surgery On Ligament Repairs
Surgery can not prevent the development of osteoarthritis after knee injuries.
OAK BROOK, Ill. – Arthroscopic surgical repair of torn anterior cruciate ligaments (ACL) or meniscal cartilage injuries in the knee does not decrease the chances of developing osteoarthritis, according to a new study published in the online edition and August print issue of the journal Radiology.
There's a lesson in this sort of report: Surgery falls way short of full repair of tissue damage. The long term effects of those injuries is to accelerate aging. Surgery is inadequate because surgeons can not instruct cells how to do repairs.
If you've had an ACL tear or cartilage damage then osteoarthritis lies in your future until cell therapies and gene therapies are developed that can do full repair.
A decade after the initial injuries were diagnosed using MRI, localized knee osteoarthritis was evident in patients, regardless of whether or not the injuries had been surgically repaired.
"This study proves that meniscal and cruciate ligament lesions increase the risk of developing specific types of knee osteoarthritis," said Kasper Huétink, M.D., the study's lead author and resident radiologist at Leiden University Medical Center in the Netherlands. "Surgical therapy does not decrease that risk."
Gotten yourself pretty banged up by sports, yard work, or an accidental fall? You need the development of gene therapies and cell therapies to render you fully repaired. Otherwise painful arthritis lies in your future.
"If you've had an ACL tear or cartilage damage then osteoarthritis lies in your future until cell therapies and gene therapies are developed that can do full repair."
There are, in fact, things you can do right now. They're not as effective as stem cell or gene therapy could be, but they're not futile. After I broke my leg back in the 90's, I developed traumatic arthritis. (I wouldn't be the least bit surprised if that was a factor in this study; Traumatic arthritis is distinguished from osteoarthritis only by the fact that it's triggered by trauma. Surgery is traumatic...)
My doctor was predicting that I'd need a joint replacement in a few years, as i could already barely walk, and had me on Naproxen. Not being keen on that, I did some research, and ended up taking S-Adenosyl methionine, 'SAMe". Within a year, my joint was essentially back to normal, and didn't bother me even if I stopped taking it. Not immediately, anyway... I did say it's not as effective as stem cell treatments might be.
I'd really advise anybody who gets any kind of cartilage damage to give it a try. At the very least, it will suppress the inflammation about as effectively as the usual non-steroidal anti-inflammatories, but without the risk of liver damage.
Glucosamine? Unless you're getting it directly injected into the joint, probably not very effective.
Cetyl Myristoleate is also worth looking into.
"Surgical therapy does not decrease that risk." Meniscectomy, which is the surgical removal of all or part of a torn meniscus, did not reduce that risk.
It's repairing the meniscus that may help. We know that meniscus removal leads to DJD. Repairing it might help. Reconstructing the ACL may reduce the rate of degeneration and to give a knee that is stable. We cannot fix the articular cartilage very well at present. That's where we need advances and it's what we surgeons want as much as anyone.
Alea iacta est, the die is cast when the injury occurs.
I tore my medial meniscus about 8 years ago. At first I did not even know what had happened. It was only when I found that I couldn't run more than 5 or 6 steps without stabbing pain. At that point I found a orthopedist used to treating injuries in those who exercise. When we talked about surgery I asked him if the surgery (partial removal of the meniscus with smoothing the edges) would speed development or arthritis. His answer was, "You are going to have arthritis anyway, but with the surgery you will be able to run."
Eight years later I have no obvious osteoarthritis symptoms, can still run, although I have largely switched to cycling for exercise. The crepitation in the bad knee is pretty much the same as in the 'good' knee. I have been involved in an osteoarthritis study for close to 6 years now. I have noticed that on the question "How many months a year do you have pain in your knee more than half the days?" that my 'yes' answers to that question have gone down.
If you visit again, question: How do you think the problem will ultimately be solved?
For example, what do you think the prospects are for creating cartilage outside of the body to then surgically implant?
Or is a cell therapy embedded into an implantable material on top of the injury a better prospect for how the repair will ultimately be done?
The surgery, if done right, does not increase the probability of osteoarthritis. That is caused by loss of articular cartilage (that lines the bone surfaces, e.g., the tibial plateau) covering the nerve endings. The articular cartilage is weakened or killed by the trauma of the initial injury- in research at Michigan State, sponsored partly by the auto industry, they found that if you whacked a bunny's knee, the way yours could hit in the dashboard in a collision, the articular cartilage was locally killed. Until you have a solid, and affordable, way to re-line the condyles and other joint surfaces (polymers don't do it- they protect well, but always pop loose from the bone surface after a couple of months), you risk arthritis- and it is not the surgeon who causes it.