SPORTS INJURIES
Surgical Alternatives to Knee Ligament Surgery
The complications of orthopedic surgery on knee ligaments are
significant and frequent. The ligament grafts are profoundly
weakened about eight weeks after surgery. At this time their
strength is about 10 percent of its initial strength! It
is only 50 percent of initial strength after one year. In
two to three years the grafts are at their strongest, and
then, less than their initial strength. (Tria, A. Ligaments
of the Knee. New York, NY: Churchill Livingstone Inc., 1995,
p. 167.) Compare this to one study where ligament strength
was measured after a six-week period of doing Prolotherapy
on knee ligaments. The results showed that in every case
Prolotherapy increased ligamentous mass, thickness, and cross-sectional
area as well as the ligament strength. Prolotherapy in a
six-week period increased ligament mass by 44 percent, ligament
thickness by 27 percent, and the ligament-bone junction strength
by 28 percent.(Liu, Y. An in situ study of the influence
of a sclerosing solution in rabbit medial collateral ligaments
and its junction strength. Connective Tissue Research. 1983;
2:95-102.)
There are other techniques for ACL problems, including artificial grafts These
artificial grafts (e.g., Gortex) lead to particularly poor results with very
high complications! (Paulos, L. The Gore-tex anterior cruciate ligament prosthesis.
A long-term follow up. American Journal of Sports Medicine. 1992; 20:246-252.
Letsch, R. Replacement of the anterior cruciate ligament by a PET prosthesis
(Trevira extra-strength as a salvage procedure in chronically unstable previously
operated knee joints). Unfallchirurgie. 1994; 20:293-301.)
Arthrofibrosis (a scarred, painful, stiff, knee with limited use) followed arthroscopic
ACL reconstruction in 10 percent of the cases, when associated with the repair
of a torn meniscus! (Austin, K. Complications of arthroscopic meniscal repair.
American Journal of Sports Medicine. 1993; 21:864-868.)
In an Australian study, patients were followed up after 7.4 years. Fifty-seven
percent had pain on exertion. There was an overall significant deterioration
of the anterior-posterior stability of the knee, indicating a failure of the
ligament graft integrity with time.(68. Cross, M. Acute repair of injury to the
anterior cruciate ligament. A long-term follow up. American Journal of Sports
Medicine. 1993; 21:128-131.) In another study of patients followed for two to
seven years after surgery, seven percent of the grafts failed and another 26
percent had only "fair" results. (Noyes, F. Reconstruction of the anterior ligament
with human allograft. Comparison of early and later results. Journal of Bone
and Joint Surgery (American) 1996; 78: 524-537.)
The truly phenomenal news is that Prolotherapy has been shown to stimulate healing
in torn cruciate ligaments! The main evidence for this are the many athletes
already healed by Prolotherapy. In a small study of athletes who had torn the
cruciate ligaments, the knees were examined with a commercially-available computerized
instrument, called an electrogoniometer, before and after Prolotherapy to their
knees. The results were wonderful! The joint looseness was significantly decreased
and the pain was markedly reduced or eliminated. They returned to a higher level
of functioning, many returning to sports. (Ongley, M. Ligament instability of
the knees: a new approach to treatment. Manual Medicine. 1988; 3:152-154.) Even
more impressive were the results of a double-blind placebo-controlled study of
dextrose Prolotherapy for knee osteoarthritis with and without ACL laxity, performed
by K. Dean Reeves, M.D. The study participants had six months or more of pain,
along with either grade 2 or more joint narrowing or grade 2 or more osteophytic
change in any knee compartment. A total of 38 knees were completely void of cartilage,
radiographically, in at least one compartment. The study involved the injection
of a dextrose Prolotherapy solution, bimonthly, comparing it to a control solution
into 111 knees in 68 patients with osteoarthritis. The results showed that at
12 months, after six injections, the dextrose-treated knees improved in pain
(44% decrease), swelling complaints (63% decrease), knee buckling frequency (85%
decrease), and in flexion range (14 degree increase). Analysis of blinded radiographic
readings of 0- and 12-month films revealed stability of all radiographic variables
with two variables improving with statistical significance (lateral patellofemoral
cartilage thickness and distal femur width in millimeter, both of which signify
cartilage growth). Knees with ACL laxity showed statistically significant improvements
in pain, swelling, joint flexion, and joint laxity. Amazingly, eight out of the
13 dextrose-treated knees with ACL laxity were no longer lax at the conclusion
of one year. (Reeves, K. Randomized prospective double-blind placebo-controlled
study of dextrose Prolotherapy for knee osteoarthritis with and without ACL laxity.
Alternative Therapies 2000; 2:68-80.) These results were with only one Prolotherapy
injection into the knee joints at each session. In other words, the ACL ligament
attachments were not treated separately, which is routinely done during Prolotherapy
for ACL laxity. Imagine what the results would be like if the ACL itself was
treated! Yes, the athlete has a choice-Prolotherapy or surgery.
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