Associate Professor Miniter has recently attended the EFORT conference in Barcelona. The conference concentrated on many aspects of surgical reconstruction. One particular lecture series concentrated upon the necessity or otherwise of a knee reconstruction. There were a number of very good presenters. One particular study spoke about the timing of anterior cruciate ligament reconstruction. As part of this presentation, the discussion centred as to whether people would require a knee reconstruction. A Kanon trial which has been done over the last ten years has indicated that about 50% of people require ACL reconstruction.
These studies were done in Scandinavia where there is no impetus to provide the service unless the patient really requires it. Therefore, in a situation where an acute knee injury has occurred, we, as responsible surgeons, need to have a careful discussion with the patient as to whether any type of surgery is indicated. Early physiotherapy is appropriate in most cases and some people will require immediate reconstruction if their knee is unstable or if they have a particular type of meniscal tear. However, not all people will require knee reconstructive surgery. With this in mind, and with the results of the Kanon trial in mind, we need to be selective in our surgical planning. I was also fortunate to meet the head of the European Soccer Federation on the way home from Europe. There was a simultaneous isokinetic conference which was effectively a meeting of 3000 people around the world who sole interest is the provision of services to the professional soccer teams of the world. The general opinion from this group of persons was that ACL reconstruction will, of course, be required in professional athletes. This seems to be a trend to return to the middle third patellar tendon reconstructive technique that has been the workhorse of knee reconstruction over many years.
The key to all of this is an informed discussion between surgeon and patient. The physiotherapist clearly needs to be involved, the imaging needs to be assessed, and a very careful analysis undertaken before we proceed to surgery.