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The Latest Knee Surgery Is Unproven

Date: November 15, 2016      Publication: Bottom Line Personal      Source:  Mark D. Miller, MD, University of Virginia      Print:

If you tear the anterior cruciate ligament (ACL) in one of your knees—a common occurrence—an orthoped­ic surgeon might recommend repairing it and having your anterolateral ligament repaired as well. A 2013 article in Journal of Anatomy speculated that this little-known ligament might play an important role in providing rotational stability to the knee, and media reports trumpeting the “discovery” of this new ligament soon followed. In truth, nothing new had been discovered—the anterolateral ligament has been described in medical literature since at least the 19th century. Now some surgeons have begun reconstructing damaged anterolateral ligaments when torn ACLs are reconstructed.

Trouble is, there currently is no evidence that the anterolateral ligament is important or that repairing it is beneficial. This procedure even might turn out to be damaging to the knee—drilling tunnels in leg bones to reattach this repaired ligament could potentially weaken nearby structures.

What to do: If an orthopedic surgeon recommends repairing your ­anterolateral ligament as part of an ACL reconstruction, seek a second opinion. Research is ongoing, and there is a chance that repairing the anterolateral ligament will be shown to be useful—particularly in people who have had ACL reconstructions fail in the past…or who have extreme amounts of knee instability—but that has not yet been established.

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What’s more, having your anterolateral ligament reconstructed could turn out to be a mistake even if this ligament is one day shown to be important. That’s because whether it is worth performing this procedure is not the only area of contention—there also is not yet any consensus about how to perform it.

Source: Mark D. Miller, MD, professor of orthopaedic surgery and division head for sports medicine at University of Virginia, Charlottesville. He also is a practicing orthopaedic surgeon. UVAHealth.com