More Than Half of All ACL Reconstructions Could Be Avoided, Five-Year Follow-Up Study Shows

Another Human-Based Study, and I’ve Been Proving This in Canine Cases For Over 10 Years-

From RehabDeb: This report is from human medical research, however Colorado State University has since conducted some animal studies. I would love to conduct studies with advanced exercise physiology protocol that I have been using for over 20 years even with my own pets before doing “official” vet med work. I look forward to when I have resources to do those studies.

When I began independent practice in 2007, I used my accumulated research studies, experience, and knowledge begun decades before my work in veterinary medicine in order to create some simple functional exercise and drill protocol. These programs benefited hundreds of my pet patients whose people opted to not pursue surgery. I have used these programs for both cats and dogs.

In every case where people follow my protocol (and where there are no extenuating circumstances), the pets have stabilized the knee or other joint with muscle growth and strength and with proper scar tissue (sometimes we want some scar tissue).

These pets have also functioned very well after rehabilitation. You may do all this work in the home environment with no dependence on specialized equipment in a clinic. There is no need for specialized equipment when we are drawing from centuries of known exercise physiology.

My programs for conservative (no surgery) treatment are clinically and anecdotally successful. This means that clients and veterinarians do the work and get good results. You can too, if you want to do the work 🙂

Jan. 30, 2013 — In the summer of 2010, researchers from Lund University in Sweden reported that 60 per cent of all anterior cruciate ligament (ACL) reconstructions could be avoided in favour of rehabilitation. The results made waves around the world, and were met with concerns that the results would not hold up in the long term. Now the researchers have published a follow-up study that confirms the results from 2010 and also show that the risk of osteoarthritis and meniscal surgery is no higher for those treated with physiotherapy alone.

“We have continued with our study and for the first time are able to present a five-year follow-up on the need for and results of ACL surgery as compared with physiotherapy. The British Medical Journal published the findings and they are basically unchanged from 2010.

This will no doubt surprise many people, as we have not seen any difference in the incidence of osteoarthritis,” says Richard Frobell, one of the researchers behind the study, who is an associate professor at Lund University and a clinician at the orthopaedic department, Helsingborg Hospital.

Richard Frobell explains that the research group’s results from 2010, which were published in the New England Journal of Medicine, caused a stir and questions were raised as to whether it was possible to say that an operation would not be needed in the long term.

Half of the patients who were randomly assigned not to undergo reconstructive surgery have had an operation in the five years since, after they experienced symptoms of instability.

“In this study, there was no increased risk of osteoarthritis or meniscal surgery for ACL injury treated with physiotherapy alone compared to treated with surgery. Neither was there any difference in patients’ experiences of function, activity level, quality of life, pain, symptoms or general health,” says Richard Frobell.

“The new report shows that there was no difference in any outcome between those who had operations straight away, those who had operations later, and those who did not have an operation at all.

“The message to the medical experts who are treating young, active patients with ACL injuries is that it may be better to start by considering rehabilitation rather than operating straight away.

In Sweden, over 5000 people every year suffer an anterior cruciate ligament injury, mainly young people involved in sport. There are different schools of treatment and Sweden stands out with treatment that is in line with the results of the study.

“On an international front, almost all of those with ACL injuries have operations. In Sweden, just over half have surgery, but in southern Sweden we have been working for many years to use advanced rehabilitation training as the first method of treatment. Our research so far has confirmed that we are right in not choosing to operate on these injuries immediately. Longer-term follow-up is important to look more closely at the development of osteoarthritis in particular,” says Richard Frobell.

KANON, Knee ACL NON-operative versus operative treatment is the name of the research group. They are now moving on to the next stage. This year, the third part of the study will begin, following up the patients ten years after acl injury.

Richard Frobell has also entered into a collaboration with researchers at the School of Economics and Management at Lund University. He is evaluating the health economics aspects of different treatment methods for ACL injury.

Journal References

  • R. B. Frobell, H. P. Roos, E. M. Roos, F. W. Roemer, J. Ranstam, L. S. Lohmander. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ, 2013; 346 (jan24 1): f232 DOI:10.1136/bmj.f232
  • Richard B. Frobell, Ewa M. Roos, Harald P. Roos, Jonas Ranstam, L. Stefan Lohmander. A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears.New England Journal of Medicine, 2010; 363 (4): 331 DOI:10.1056/NEJMoa0907797

From ScienceDaily

Physical Therapy as Effective as Surgery for Torn Meniscus and Arthritis of the Knee, (Human) Study Suggests

Just One of Many Studies Published on This Topic-

My programs for conservative (no surgery) treatment are clinically and anecdotally successful. This means that clients and veterinarians do the work and get good results.

Physical Therapy as Effective as Surgery for Torn Meniscus and Arthritis of the Knee, (Human) Study Suggests –

“Surgery may not always be the best first course of action.

A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. This study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.” Mar. 21, 2013 — A New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and arthritis of the knee should encourage many health care providers to reconsider their practices in the management of this common injury, according to the American Physical Therapy Association (APTA).

The study, published March 19, showed no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone.

“This study demonstrates what physical therapists have long known,” explained APTA President Paul A. Rockar Jr, PT, DPT, MS. “Surgery may not always be the best first course of action. A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. This study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.”

According to lead physical therapist for the trial and American Physical Therapy Association (APTA) member Clare Safran-Norton, PT, PhD, OCS, “our findings suggest that a course of physical therapy in this patient population may be a good first choice since there were no group differences at 6 months and 12 months in this trial.

These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options.”

Researchers at 7 major universities and orthopedic surgery centers around the country studied 351 patients aged 45 years or older who had a meniscal tear and mild-to-moderate osteoarthritis of the knee. Patients were randomly assigned to groups who received either surgery and postoperative physical therapy or standardized physical therapy. Within 6-12 months, patients who had physical therapy alone showed similar improvement in functional status and pain as those who had undergone arthroscopic partial meniscectomy surgery. Patients who were given standardized physical therapy — individualized treatment and a progressive home exercise program — had the option of “crossing over” to surgery if substantial improvements were not achieved. Thirty percent of patients crossed over to surgery during the first 6 months. At 12 months these patients reported similar outcomes as those who initially had surgery. Seventy percent of patients remained with standardized physical therapy.

According to an accompanying editorial in NEJM,”millions of people are being exposed to potential risks associated with a treatment [surgery] that may or may not offer specific benefit, and the costs are substantial.” Physical therapist and APTA member Mary Ann Wilmarth, PT, DPT, MS, OCS, MTC, Cert MDT, chief of physical therapy at Harvard University, said, “Physical therapists are experts in improving mobility and restoring motion. The individualized treatment approach is very important in the early phases of rehabilitation in order to achieve desired functional outcomes and avoid setbacks or complications.”

Story Source:

The above story is reprinted from materials provided by American Physical Therapy Association. Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:
Jeffrey N. Katz, Robert H. Brophy, Christine E. Chaisson, Leigh de Chaves, Brian J. Cole, Diane L. Dahm, Laurel A. Donnell-Fink, Ali Guermazi, Amanda K. Haas, Morgan H. Jones, Bruce A. Levy, Lisa A. Mandl, Scott D. Martin, Robert G. Marx, Anthony Miniaci, Matthew J. Matava, Joseph Palmisano, Emily K. Reinke, Brian E. Richardson, Benjamin N. Rome, Clare E. Safran-Norton, Debra J. Skoniecki, Daniel H. Solomon, Matthew V. Smith, Kurt P. Spindler, Michael J. Stuart, John Wright, Rick W. Wright, Elena Losina. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine, 2013; : 130318220107009 DOI:10.1056/NEJMoa1301408

When Should I Begin Rehab on My Pet?

Rehabilitation Begins Immediately!

Begin rehabilitation immediately by taking proper care of your injured pet or your pet that has had surgery . Timing is key to the best recovery. Whenever you or your pet are injured, beginning proper movement as soon as possible is very important to recovery.

Timing of activity and recovery are especially important in the sporting pet world (dogs, horses, etc.), where workout programs and drills are designed for competition training and injury recovery.

Bella the dog playing in water with her person a year after recovering from several issues
Bella the Wonder Dog Being her Athletic Self

Learning how and when to do particular activities with your pet after injury or surgery is all part of rehabilitation. From going outside to potty (for a dog) to climbing the indoor kitty tree to running wildly and free; all in the right timing will make you and your pet’s lives easier.

The care you give when you and your pet are together and how you care for them when you are not with them is all a part of rehabilitation.

white plastic pen for small dogs
Gracie Crate for Bedroom

The information on this website will help you to begin rehabilitation and work on doing the best rehab you are able, because your pet deserves it!

Blessings-

Rehabdeb

 

Updated February 17, 2018

 

Why Do Rehabilitation for Your Pet?

Is Pet Rehabilitation Helpful or Necessary?

Pet rehabilitation may be done by anybody who has the time to do it and will follow directions. You should see benefits from a good program within the first week if you are doing the right work for the problem!

pet rehabilitation for Wolf the Horse receiving laser therapy from me
Wolf the Horse

A proper rehabilitation program should increase function where at all possible, and it subsequently could improve quality of life on many levels.

Pet rehabilitation programs are helpful for any animals that…

  • have either had surgery or have not
  • need improved muscle tone, connective tissue strength, and overall health before going into surgery
  • are old or young and could benefit from quality-of-life improvements because they have some sort of function issues
  • need advanced conditioning for a new or changed living environment
  • are competitive and need sport training for improved conditioning and injury prevention
  • are overweight or obese and need a properly-designed exercise plan
Great Dane Miss Moneypenny Taking a Break From Rehabilitation
Great Dane Miss Moneypenny Taking a Break From Pet Rehabilitation

See this post on Goals of Therapeutic Exercise for more info.

I bet you already know why rehabilitation is a good idea, so I’m going to enable comments for this page for when you would like to tell me your “why”!

Thanks!

Rehabdeb

Updated February 17, 2018

Veterinarian Comments and Reviews

You may find more positive veterinarian comments and reviews around the web. Below are a couple I have copied from various web locations –

“We are so grateful for the expertise and compassion you provide the central/south Texas community!”
Mission Veterinary Specialists, San Antonio, TX

“Once again, thanks for engaging the veterinary industry and client owners with your work and experience. I enjoy your enthusiasm and passion for the area.”
DVM, ACVS (American College of Veterinary Surgeons), South Texas

“Thanks so much, Deborah! The book is impressive. Maybe you should leave a copy at (some shelters) since they put so many cruciate dogs on the euthanasia list…Great work and thank you!”
DVM, Austin, TX

“Read your book. Excellent job. Now at ACVS they are all for non surgical acl (rehab)…Good job!”
DVM, Austin, TX

book cover of my non-surgical recovery booklet

“Finished reading “instead of surgery” kindle booklet. Bueno! Great discussion on importance of pain control, in particular. ”
DVM, Austin, TX

“Hi Deborah! I read your book the night I got it. I really like it and have already recommended it to a client last week. I hope she bought it. I will write a review for amazon for you, too. I hope you are really successful in this. I know how hard you work!”
DVM, Kerrville, TX

“Once again, thanks for engaging the veterinary industry and client owners with your work and experience. I enjoy your enthusiasm and passion for the area.”
DVM, ACVS, South Texas

“Great plan outline! I’ve come to think that using the water treadmill is (overrated), and it’s nice to finally have a definitive plan to get clients on the road to recovery.
DVM, ACVS, Austin, TX

“Just wanted you to know I read and appreciated the CCL rehab book, I will likely keep a few in the clinic.”
DVM, Austin, TX

“Bought one of your books last week. Its great!”
Megan Kelly BVSc DIPVET CCRP Holistic Veterinary Surgeon, Cape Town, South Africa

Please see client reviews and testimonials by clicking on either ^^ word in bold color ^^ 🙂

Thanks! Rehabdeb

(Updated February 10, 2018)