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After ACL Reconstruction, why do so many patients injure their contralateral knee?

post #1 of 6
Thread Starter 

If you blow your left ACL, you are at higher risk to blow your right ACL.

 

These are my theories:

  • Pre-disposing factors for ACL injury remain the same, such as, female (anatomic alignment, neuromuscular imbalance, hormonal fluctuation), anyone (narrow tunnel for ACL/PCL, narrow intercondylar notch, poor ratio of hamstring strength to quadriceps strength, initial joint laxity, poor sports technique)
  • Under-rehabilitation of the "good". The focus is on getting the quad & hamstring strength returned in the bad leg, and improving proprioception on the bad leg, that the "good" leg is often ignored.
  • Overcompensation putting more forces on the "good". Such as landing a jump with more weight on the uninjured limb. Fear of re-injury causes one to use the "good" one more often. Maybe some kind of interaction with fatigue caused by brace and change in mechanics?

 

For the ones in the business, am I heading down the right path? At first I thought it was all about overcompensation, but now I'm thinking under-rehabilitation of the contralateral leg may be an even larger factor.

 

Interesting tidbit: It appears ACL injuries occur significantly more frequently in the left leg.

post #2 of 6
I injured my knee very badly (tibial plateau fracture with significant collateral damage to ligaments etc). One Of the most frustrating aspects of the rehab is that I have had several problems with the other leg - hamstring, achilles tendon and runners knee. So when I am trainng it is the leg which didn't suffer the traumatic injury which limits my performance and which I am always worried about.

I think this experience leads to tentative rejection of your first hypothesis in my case since the injury types and mechanisms are quite different. I don't think I neglected the "good" leg in rehab, so the third hypothesis seems to make most sense to me, especially as all the problems have occured while running in forest tracks which is an activity which allows for some kind of overcompensation.
post #3 of 6

Hope you are wrong as I have blown my right ACL twice, but nothing on the left other than a minor MCL many years ago.  Prior to the ACLs, I had blown a right achilles (playing basketball) and think that this may have put the right ACL at greater risk (due to the hard scar tissue) but this is only speculation.

 

I would tend to lean towards your first theory and would add sports/activities engaged in as a pre-disposing factor (although maybe this is what you meant by poor sports technique).

 

More food for thought- I wear a brace on my right, but not my left leg.

 

Question- For someone with a blown/repaired left ACL, are they at a higher risk to blow their right or left ACL going forward?  AKA, are you more likely to blow your "good" knee or repaired knee?    

post #4 of 6

that's because most people are right-footed.....  no mystery there at all.  

Quote:
Originally Posted by rx2ski View Post

If you blow your left ACL, you are at higher risk to blow your right ACL.

 

These are my theories:

  • Pre-disposing factors for ACL injury remain the same, such as, female (anatomic alignment, neuromuscular imbalance, hormonal fluctuation), anyone (narrow tunnel for ACL/PCL, narrow intercondylar notch, poor ratio of hamstring strength to quadriceps strength, initial joint laxity, poor sports technique)
  • Under-rehabilitation of the "good". The focus is on getting the quad & hamstring strength returned in the bad leg, and improving proprioception on the bad leg, that the "good" leg is often ignored.
  • Overcompensation putting more forces on the "good". Such as landing a jump with more weight on the uninjured limb. Fear of re-injury causes one to use the "good" one more often. Maybe some kind of interaction with fatigue caused by brace and change in mechanics?

 

For the ones in the business, am I heading down the right path? At first I thought it was all about overcompensation, but now I'm thinking under-rehabilitation of the contralateral leg may be an even larger factor.

 

Interesting tidbit: It appears ACL injuries occur significantly more frequently in the left leg.

post #5 of 6
Thread Starter 
Quote:
Originally Posted by MEfree30 View Post

 

Question- For someone with a blown/repaired left ACL, are they at a higher risk to blow their right or left ACL going forward?  AKA, are you more likely to blow your "good" knee or repaired knee?    

 

The studies indicate that if you have torn the ACL in one knee, you are at higher risk of blowing your contralateral (the other uninjured) knee.

I don't think I've seen one that has directly compared re-tearing the repaired knee versus tearing the good knee. But I'll look.

post #6 of 6
Thread Starter 

Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction: a prospective MOON cohort study.

 

http://www.ncbi.nlm.nih.gov/pubmed/17452511

 

(This was a 2 year follow-up.)

 

CONCLUSION:

The contralateral normal knee anterior cruciate ligament is at a similar risk of anterior cruciate ligament tear (3.0%) as the anterior cruciate ligament graft after primary anterior cruciate ligament reconstruction (3.0%).

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