Baltimore’s Mercy Medical Center orthopedic surgeon, Dr. John-Paul Rue talks about preventing ACL arthritis in youth.
Interview conducted by Ivanhoe Broadcast News in 2023.
You get a chance to take a peek after somebody has had an ACL injury and you do see a arthritis. It’s a problem for the young people that have it. Can you explain that?
Rue: Yes. One of the devastating problems with an ACL injury is that it typically happens in a younger patient; very athletic, active patient. Many of them don’t have any arthritis, have never had a problem and they have this devastating injury. While orthopedic surgeons have become very good at replacing or rebuilding the ACL for stability, we have not solved the problem of post-traumatic osteoarthritis or the future arthritis that may develop in a person’s knee.
Can I do anything to prevent it or is it just happens and goes with it?
Rue: We do believe that replacing or rebuilding or fixing the ACL tear is important because it lessens the chances of recurrent meniscus injuries. Lessens the chances of needing more surgeries, but it has not been shown definitively to prevent the progression of arthritis in the future. That’s a very big problem that we need to look at in big groups of participants.
I think arthritis is a deceptive term because it sounds rather innocuous and is it? Witness the finger pointing the wrong way. Why is that an issue and why especially osteoarthritis?
Rue: Post traumatic osteoarthritis is a very big problem in this country because by its definition, it happens after a trauma, after an injury. Arthritis developing after an injury in a young person because of their longevity, because of their lifespan, is a problem. Arthritis is inflammation of the knee. We use it for wear and tear of the knee, but in this particular situation, there has been an injury that has happened to the cartilage, the soft lining of the ends of the bones. That injury over time, progresses and ultimately leads to wearing out and narrowing of the joint and essentially getting to the point where the bones can actually be bone on bone and causing pain.
Along the timeline of life, when is that likely to set in?
Rue: Today we still recommend, and it is the standard of practice, that if someone who’s young and healthy and active tears their ACL, they need to get that fixed. We do ACL reconstructions fairly routinely and were very successful getting people back to their level of activity. Whether that’s sports or just day-to-day activities with family. Over the course of years, arthritis has been shown to set in whether they get the ACL fixed or not. But it’s the quality of life that we’re looking for to retain and maintain by rebuilding and fixing that ACL injury tear.
So you’re talking about the severity of the actual condition of arthritis and getting it fixed?
Rue: Yes. We’re talking about when you have an ACL tear even if you had no arthritis. If we fast forward 20 years down the road, unfortunately, we know that even if they’ve had success with having a good life with their knee, allowing them to play sports, they often end up having some arthritis regardless of what has been done.
I want to throw in just one last question tying in the two together, the cuff thing, can you explain that?
Rue: Yes. There’s a variety of rehabilitation modalities that are out there. One of the newer modalities is blood flow restriction. The idea of that is essentially a tourniquet on the leg or the arm to basically allow blood flow to collect in that leg to allow the muscles to strengthen more efficiently. It’s a little bit controversial, but it does have some good evidence that it may be beneficial in certain circumstances.
It’s counter intuitive to me to think about that. You’re going to restrict it, but you don’t tie it or you don’t put it on tight enough to restrict the artery, right?
Rue: Yes and it’s obviously done by professionals who are qualified and licensed to do this procedure, but when done under the correct supervision, what it allows is that patient to get a more robust workout for those muscles by that modality.
Is there now a cuff made specifically for that or do you just use a regular old blood pressure cuff?
Rue: Yes. There are very specific blood flow restrictions. They need to be very specifically designed so they don’t cause damage. They’re different than a tourniquet we may use in surgery for example.
How do they differ from a standard blood pressure cuff and how they look?
Rue: They’re going to be a more dynamic type of device. They’re going to be specially tailored for that situation and monitored very closely.
END OF INTERVIEW
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