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Surgical Alternatives to Knee Ligament Surgery
Ross Hauser, M.D.
Marion Hauser, M.S.,R.D.
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.(1) 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.(2)
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!(3)
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!(4)
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.(5)
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. (6)
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. (7)
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. (8) These results were with only one
Prolotherapy injections 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.
1. Tria, A. Ligaments of the Knee. New York, NY:
Churchill Livingstone Inc., 1995, p. 167.
2. Liu, Y. An in situ study of the influence of a sclerosing solution in rabbit
medial collateral ligament and its junction strength. Connective Tissue
Research. 1983; 2:95-102.
3. 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.
4. Austin, K. Complications of arthroscopic meniscal repair. American Journal of
Sports Medicine. 1993; 21:864-868.
5. 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.
6. 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.
7. Ongley, M. Ligament instability of the knees: a new approach to treatment.
Manual Medicine. 1988; 3:152-154.
8. 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.
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