Increased risk of osteoarthritis in acl injuries?

[Steven830]

Hi, I'll begin by explaining my situation! I'm 27 year old semi professional footballer. Back in 2008 I injured my knee which was diagnosed as a torn cartilage however when I woke up from surgery the surgeon informed me that I had an absent Acl! Because it wasn't diagnosed initially ( even after an MRI scan) over the 8 months it took to get the operation the acl had worn away and the surgeon said there was nothing there which he could reattach and that reconstruction would be the best possible option! Six weeks after the op we met and he said that I wouldn't need another op that I should go back and strengthen up the muscles around the knee and see how it goes. Fortunately i have been back playing now for over a year without any major problems! My main concern is that I am doing more damage to my knee and significantly increasing the risk of osteoarthritis in my knee in the future? When I put this point to the surgeon he stated that reconstruction would not help delay the onset of osteoarthritis as because the damage was already done! I'm now thinking about giving up football as I work as a joiner and realise that arthritis in my knee is going to cause many problems later in life where my work is concerned! I would appreciate any ones opinion about the increased risk of osteoarthritis if I keep playing football I'm my current condition! Thanks.

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[Dr Damien]

Dear Steven830

I do not feel your stopping football will reduce the chances of you not developing knee arthritis...only because you have had significant trauma to the joint...even people who have not had the sporting life and injuries still develope arthritis anyway...

obviously if you do not have the ACl anymore, instrinsic stability of your knee joint will be affected and tendency for abnormal arthrokinematics happening, meaning there is a possibility of you having certain aspects of your cartilage experiencing more load than others. Also because one aspect has been damaged then this risk is even greater.

I guess rather than ask whether this problem you have with your knee will end up in arthritis, the question should be how quickly this will happen. That is difficult to answer because it is depending on how much you use that knee...

it is perhaps sensible to ease off on the football only because you feel this would affect your livelihood should an early onset of arthritis occurs. However this risk can happen even in your daily life without the event of high impact sports. I think the only risk to your knee would be an event of reinjury considering the stability is non optimal....

I would suggest having an x-ray of this knee now...compared to an x-ray of the good knee...see how much joint space difference there is (if there is any)...this would give you an incline to how quickly arthritis will develope....

if you are very desperate...you might want to have your knee analyzed by a physiotherapist for proper biomechanics, to see whether there is excessive rolling, translation occurring during your walking sitting, running etc...this can be corrected and with conscious effort, good advise about foot wear and learning how to protect the knee might delay the onset of o.A...your surgeon is right that you need the maximal effect of your dynamic stabilizers to compensate for problems with ligament stability so your knee strengthening exercises are important...

It is however a shame to give up something you obviously love because of an uncertainty that is likely to happen anyway with or without the sporting activity...