Saturday, August 28, 2010
Friday, August 27, 2010
Tuesday, August 24, 2010
Cross Country Running: a winter sport?
http://espn.go.com/action/freeskiing/blog/_/post/5480597
Last week, the International Olympic Committee announced it had received a request from track and field's world governing body (IAAF) to add cross-country running to the Olympic docket.
The Winter Olympic docket, starting in 2018.
Generally this wouldn't warrant coverage on a freeskiing site, but given that halfpipe skiing is under heavy consideration to be included at the 2014 Sochi Games (in addition to slopestyle snowboarding, women's ski jumping and an alpine racing team event), there suddenly exists a real possibility that Olympic athletes could be running on snow before they'd be launching 20 feet out of a pipe.
According to an Associated Press story on the cross-country bid, the Olympic Charter states that "only those sports which are practiced on snow and ice are considered as winter sports." But the IOC also strives for universality among its sport offerings, and with only 82 of 200 Olympic nations having participated in this year's Vancouver Games, the addition of cross-country running could vastly increase that number, especially among African countries.
U.S. Cross Country champ Deena Kastor: future winter Olympian?
As expected, the running community is celebrating the news. Deena Kastor, the 2004 Olympic marathon bronze medalist and an eight-time U.S. cross-country champion, lives and trains in Mammoth Lakes, Calif., along with many of America's top runners. "I think it's fantastic," she said in a phone interview. "Running is a year-round sport. In the winter months it's a pretty extreme sport, but running in general is the most participated sport in the world."
Kastor said the Winter Olympic potential has been talked about for years at events ranging from small cross-country races to the Summer Games. "It was always a pipe dream," she said. But given the conditions in which many of the world's elite runners train, she believes the winter bid is fair. "I live at 8,000 feet. We get 50 feet of snow each year. This winter we had snow from October to May. I run about 20 to 30 miles a week on the snow (out of 110 miles total), in spikes, crampons, whatever. To me, the worse the conditions, the better."
Peter Olenick, a two-time Winter X Games medalist in the halfpipe and a potential Olympic contender in 2014, doesn't share the runners' view. "I think that's absolutely ridiculous," he said of the IAAF request. "Winter sports involve actually sliding on snow or ice, not just doing a summer sport in the winter. I've never even heard of cross-country running in the winter."
Jonny Moseley, the 1998 Olympic moguls gold medalist and also a cross-country runner in high school, remains dubious on whether halfpipe skiing would be prioritized ahead of an objective event like running. "I think they just hate judged sports," he said of the IOC. "It's too much of a hassle for them."
Tom Kelly, vice president of communications at the U.S. Ski and Snowboard Association, first learned of the news earlier this week. "I can honestly tell you we've never had any discussions on this at all. So there's no way we'd have a position on it," he said. "But it is pretty fascinating. And we have high regard for the process at the IOC. They put a lot of time and thought into adding sports."
The potential 2014 additions could be decided as early as October, when the IOC's executive board meets in Acapulco, Mexico. But the cross-country fate likely won't be known until next July, when the 2018 host city is chosen.
Last week, the International Olympic Committee announced it had received a request from track and field's world governing body (IAAF) to add cross-country running to the Olympic docket.
The Winter Olympic docket, starting in 2018.
Generally this wouldn't warrant coverage on a freeskiing site, but given that halfpipe skiing is under heavy consideration to be included at the 2014 Sochi Games (in addition to slopestyle snowboarding, women's ski jumping and an alpine racing team event), there suddenly exists a real possibility that Olympic athletes could be running on snow before they'd be launching 20 feet out of a pipe.
According to an Associated Press story on the cross-country bid, the Olympic Charter states that "only those sports which are practiced on snow and ice are considered as winter sports." But the IOC also strives for universality among its sport offerings, and with only 82 of 200 Olympic nations having participated in this year's Vancouver Games, the addition of cross-country running could vastly increase that number, especially among African countries.
U.S. Cross Country champ Deena Kastor: future winter Olympian?
As expected, the running community is celebrating the news. Deena Kastor, the 2004 Olympic marathon bronze medalist and an eight-time U.S. cross-country champion, lives and trains in Mammoth Lakes, Calif., along with many of America's top runners. "I think it's fantastic," she said in a phone interview. "Running is a year-round sport. In the winter months it's a pretty extreme sport, but running in general is the most participated sport in the world."
Kastor said the Winter Olympic potential has been talked about for years at events ranging from small cross-country races to the Summer Games. "It was always a pipe dream," she said. But given the conditions in which many of the world's elite runners train, she believes the winter bid is fair. "I live at 8,000 feet. We get 50 feet of snow each year. This winter we had snow from October to May. I run about 20 to 30 miles a week on the snow (out of 110 miles total), in spikes, crampons, whatever. To me, the worse the conditions, the better."
Peter Olenick, a two-time Winter X Games medalist in the halfpipe and a potential Olympic contender in 2014, doesn't share the runners' view. "I think that's absolutely ridiculous," he said of the IAAF request. "Winter sports involve actually sliding on snow or ice, not just doing a summer sport in the winter. I've never even heard of cross-country running in the winter."
Jonny Moseley, the 1998 Olympic moguls gold medalist and also a cross-country runner in high school, remains dubious on whether halfpipe skiing would be prioritized ahead of an objective event like running. "I think they just hate judged sports," he said of the IOC. "It's too much of a hassle for them."
Tom Kelly, vice president of communications at the U.S. Ski and Snowboard Association, first learned of the news earlier this week. "I can honestly tell you we've never had any discussions on this at all. So there's no way we'd have a position on it," he said. "But it is pretty fascinating. And we have high regard for the process at the IOC. They put a lot of time and thought into adding sports."
The potential 2014 additions could be decided as early as October, when the IOC's executive board meets in Acapulco, Mexico. But the cross-country fate likely won't be known until next July, when the 2018 host city is chosen.
Tuesday, August 17, 2010
Are we addicted to our sport?
http://www.nytimes.com/2010/08/17/health/nutrition/17best.html
When Dr. Michael Joyner, an exercise researcher at the Mayo Clinic, heard I’d gotten a second stress fracture, high on my fibula, less than two years after recovering from my first one, in a metatarsal bone in my foot, he sent me some advice by e-mail.
Well
“I would urge you to take a year off of running,” he wrote. “Stop trying to rope-a-dope this. Cycle and do the elliptical and take some swimming lessons.” He added, “I did — took 10 years off of running and my perspective is different.”
Right. He’s got to be kidding. I am one of those people who seem to lurch from injury to injury but keep coming back to my sport. I also am a serious cyclist, but running is my true love.
I’m not alone. Margaret Martonosi, one of my running friends and an electrical engineering professor at Princeton University, is a runner and a competitive swimmer. Last year, she injured her Achilles’ tendon. She took a month off and finally saw a doctor, who told her that her running days were over and that at age 45, she really shouldn’t be running anyway.
That was “a bit incongruous,” Margaret told me, because she had just had her best times ever in the New York marathon and in a half marathon she ran while training for it.
She changed doctors.
What is the difference between Mike Joyner and athletes like Margaret or me? Or between us and the legions of others in the Joyner camp — people like Dr. Michael Weiner, an Alzheimer’s researcher who told me he used to run marathons but took up swimming when his back kept bothering him. Now he belongs to the Dolphin Club in San Francisco. He swims with them every morning at 5 a.m. in the San Francisco Bay — without a wet suit — and never looks back. Or Dr. Jason Karlawish, an associate professor of medicine and medical ethics at the University of Pennsylvania. He reluctantly abandoned running after he tore his meniscus, a crucial piece of cartilage in the knee.
“I was frankly demoralized that I’d be one of those people who ‘used to run’ and athletics would slowly become part of my past,” Jason said. It took time and effort to learn a new sport, he added. But now he loves swimming, especially, he says, the meditative aspect. “For 45 minutes, I can see little, hear only my thoughts, and talk to no one.”.
At least one expert, recommended by the American College of Sports Medicine for this column, would say we stubborn athletes have a psychological problem.
Our behavior, said the expert, Dr. Jon L. Schriner, an osteopath at the Michigan Center for Athletic Medicine, is “compulsive”: we let our egos get in the way, persisting beyond all reason.
But another expert recommended by the college, David B. Coppel, a clinical and sports psychologist at the University of Washington, has another perspective. There are several reasons some people find it hard to switch sports, he told me. Often, their friends do that sport, too; it is how these people identify themselves, part of their social life. And then there is another, more elusive factor.
“There is something about the experience — be it figure skating or running or cycling — that really produces a pleasurable experience,” Dr. Coppel said. “That connection is probably not only at a psychological level but probably also something physiological that potentially makes it harder for these people to transition to other sports.”
Jennifer Davis, a physical chemist who is my cycling, running and weight-lifting partner, adds another reason. Often we stubborn athletes — and Jen, an ultra runner who competes in races longer than marathons, includes herself in that group — have found that we do well, get trophies, win at least our age group in races. That makes it hard to stop.
My doctor, Joseph H. Feinberg at the Hospital for Special Surgery in Manhattan, says it’s not always necessary to give up a sport because of injuries.
“Some will say you need to stop,” he said. “But often correcting faulty mechanics, the right exercises or rehab, or just changes in training techniques are all that is needed.”
He knows what it’s like to have a passion for a sport. Dr. Feinberg, a runner, swimmer and cyclist, has had two stress fractures yet keeps running.
Meanwhile, Margaret Martonosi says her tendon has improved enough that she can run two miles five days a week. It’s not much, she said, but “I’ll take it.”
I too am starting to run again. I also did so much rigorous bicycling when I could not run that I am considering entering my first bike race, a 35-kilometer time trial, which means you ride as fast as you can for 21 miles. But running is still my passion.
And Mike Joyner? He went from running to swimming and is now doing triathlons. And he’s glad.
“Whenever I have switched sports it has been energizing because it is a new set of experiences and challenges,” he said. “There are new opportunities to P.R.” (The initials stand for personal record, the best time you’ve ever had.)
“Now that I am doing more running again it feels fresh, too,” he said, “and by essentially skipping 10 years, I did not have to deal with the existential death spiral associated with progressively slower times. I came back with a blank slate.”
Margaret understands that — her swimming times had leveled off, but with running, she says, “I feel in ways like I just started, and that I have a lot more to get out of the sport.” She says there might be a day when she gives up running, but she is not there yet.
But Mike will never convince people like Jen and me.
“I could give up cycling,” Jen said. “But I could never give up running.”
When Dr. Michael Joyner, an exercise researcher at the Mayo Clinic, heard I’d gotten a second stress fracture, high on my fibula, less than two years after recovering from my first one, in a metatarsal bone in my foot, he sent me some advice by e-mail.
Well
“I would urge you to take a year off of running,” he wrote. “Stop trying to rope-a-dope this. Cycle and do the elliptical and take some swimming lessons.” He added, “I did — took 10 years off of running and my perspective is different.”
Right. He’s got to be kidding. I am one of those people who seem to lurch from injury to injury but keep coming back to my sport. I also am a serious cyclist, but running is my true love.
I’m not alone. Margaret Martonosi, one of my running friends and an electrical engineering professor at Princeton University, is a runner and a competitive swimmer. Last year, she injured her Achilles’ tendon. She took a month off and finally saw a doctor, who told her that her running days were over and that at age 45, she really shouldn’t be running anyway.
That was “a bit incongruous,” Margaret told me, because she had just had her best times ever in the New York marathon and in a half marathon she ran while training for it.
She changed doctors.
What is the difference between Mike Joyner and athletes like Margaret or me? Or between us and the legions of others in the Joyner camp — people like Dr. Michael Weiner, an Alzheimer’s researcher who told me he used to run marathons but took up swimming when his back kept bothering him. Now he belongs to the Dolphin Club in San Francisco. He swims with them every morning at 5 a.m. in the San Francisco Bay — without a wet suit — and never looks back. Or Dr. Jason Karlawish, an associate professor of medicine and medical ethics at the University of Pennsylvania. He reluctantly abandoned running after he tore his meniscus, a crucial piece of cartilage in the knee.
“I was frankly demoralized that I’d be one of those people who ‘used to run’ and athletics would slowly become part of my past,” Jason said. It took time and effort to learn a new sport, he added. But now he loves swimming, especially, he says, the meditative aspect. “For 45 minutes, I can see little, hear only my thoughts, and talk to no one.”.
At least one expert, recommended by the American College of Sports Medicine for this column, would say we stubborn athletes have a psychological problem.
Our behavior, said the expert, Dr. Jon L. Schriner, an osteopath at the Michigan Center for Athletic Medicine, is “compulsive”: we let our egos get in the way, persisting beyond all reason.
But another expert recommended by the college, David B. Coppel, a clinical and sports psychologist at the University of Washington, has another perspective. There are several reasons some people find it hard to switch sports, he told me. Often, their friends do that sport, too; it is how these people identify themselves, part of their social life. And then there is another, more elusive factor.
“There is something about the experience — be it figure skating or running or cycling — that really produces a pleasurable experience,” Dr. Coppel said. “That connection is probably not only at a psychological level but probably also something physiological that potentially makes it harder for these people to transition to other sports.”
Jennifer Davis, a physical chemist who is my cycling, running and weight-lifting partner, adds another reason. Often we stubborn athletes — and Jen, an ultra runner who competes in races longer than marathons, includes herself in that group — have found that we do well, get trophies, win at least our age group in races. That makes it hard to stop.
My doctor, Joseph H. Feinberg at the Hospital for Special Surgery in Manhattan, says it’s not always necessary to give up a sport because of injuries.
“Some will say you need to stop,” he said. “But often correcting faulty mechanics, the right exercises or rehab, or just changes in training techniques are all that is needed.”
He knows what it’s like to have a passion for a sport. Dr. Feinberg, a runner, swimmer and cyclist, has had two stress fractures yet keeps running.
Meanwhile, Margaret Martonosi says her tendon has improved enough that she can run two miles five days a week. It’s not much, she said, but “I’ll take it.”
I too am starting to run again. I also did so much rigorous bicycling when I could not run that I am considering entering my first bike race, a 35-kilometer time trial, which means you ride as fast as you can for 21 miles. But running is still my passion.
And Mike Joyner? He went from running to swimming and is now doing triathlons. And he’s glad.
“Whenever I have switched sports it has been energizing because it is a new set of experiences and challenges,” he said. “There are new opportunities to P.R.” (The initials stand for personal record, the best time you’ve ever had.)
“Now that I am doing more running again it feels fresh, too,” he said, “and by essentially skipping 10 years, I did not have to deal with the existential death spiral associated with progressively slower times. I came back with a blank slate.”
Margaret understands that — her swimming times had leveled off, but with running, she says, “I feel in ways like I just started, and that I have a lot more to get out of the sport.” She says there might be a day when she gives up running, but she is not there yet.
But Mike will never convince people like Jen and me.
“I could give up cycling,” Jen said. “But I could never give up running.”
Monday, August 9, 2010
Feeling grumpy 'is good for you'
LINK
An attack of the grumps can make you communicate better, it is suggested
In a bad mood? Don't worry - according to research, it's good for you.
An Australian psychology expert who has been studying emotions has found being grumpy makes us think more clearly.
In contrast to those annoying happy types, miserable people are better at decision-making and less gullible, his experiments showed.
While cheerfulness fosters creativity, gloominess breeds attentiveness and careful thinking, Professor Joe Forgas told Australian Science Magazine.
'Eeyore days'
The University of New South Wales researcher says a grumpy person can cope with more demanding situations than a happy one because of the way the brain "promotes information processing strategies".
He asked volunteers to watch different films and dwell on positive or negative events in their life, designed to put them in either a good or bad mood.
Next he asked them to take part in a series of tasks, including judging the truth of urban myths and providing eyewitness accounts of events.
Those in a bad mood outperformed those who were jolly - they made fewer mistakes and were better communicators.
Professor Forgas said: "Whereas positive mood seems to promote creativity, flexibility, co-operation and reliance on mental shortcuts, negative moods trigger more attentive, careful thinking, paying greater attention to the external world."
The study also found that sad people were better at stating their case through written arguments, which Forgas said showed that a "mildly negative mood may actually promote a more concrete, accommodative and ultimately more successful communication style".
His earlier work shows the weather has a similar impact on us - wet, dreary days sharpened memory, while bright sunny spells make people forgetful.
An attack of the grumps can make you communicate better, it is suggested
In a bad mood? Don't worry - according to research, it's good for you.
An Australian psychology expert who has been studying emotions has found being grumpy makes us think more clearly.
In contrast to those annoying happy types, miserable people are better at decision-making and less gullible, his experiments showed.
While cheerfulness fosters creativity, gloominess breeds attentiveness and careful thinking, Professor Joe Forgas told Australian Science Magazine.
'Eeyore days'
The University of New South Wales researcher says a grumpy person can cope with more demanding situations than a happy one because of the way the brain "promotes information processing strategies".
He asked volunteers to watch different films and dwell on positive or negative events in their life, designed to put them in either a good or bad mood.
Next he asked them to take part in a series of tasks, including judging the truth of urban myths and providing eyewitness accounts of events.
Those in a bad mood outperformed those who were jolly - they made fewer mistakes and were better communicators.
Professor Forgas said: "Whereas positive mood seems to promote creativity, flexibility, co-operation and reliance on mental shortcuts, negative moods trigger more attentive, careful thinking, paying greater attention to the external world."
The study also found that sad people were better at stating their case through written arguments, which Forgas said showed that a "mildly negative mood may actually promote a more concrete, accommodative and ultimately more successful communication style".
His earlier work shows the weather has a similar impact on us - wet, dreary days sharpened memory, while bright sunny spells make people forgetful.
Thursday, August 5, 2010
Phys Ed: How Much Does Knee Surgery Really Help?
NY TIMES article- http://well.blogs.nytimes.com/2010/08/04/phys-ed-how-much-does-knee-surgery-really-help/?src=me&ref=health
A new study published late last month in The New England Journal of Medicine is raising provocative questions about how best to treat a torn anterior cruciate ligament. For the study, researchers from Lund University in Sweden recruited 121 young adults who’d injured their A.C.L.’s. The volunteers, between 18 and 35, were physically active, and many were competitive athletes. They agreed, rather bravely, to be randomly assigned to one of two groups and accept radically different treatments for their torn A.C.L.’s. The first group began physical therapy and then underwent surgical reconstruction of the ligament, considered by many people to be the best option for injured athletes. The second group received only physical therapy, with the option to have the operation later. Twenty-three subjects of that group did eventually have the operation. (For those fortunate enough not to be personally familiar with A.C.L. surgery, reconstruction involves replacing the injured ligament with tissue from elsewhere in your own leg or from a cadaver.)
Over two years, the injured knees were assessed using a comprehensive numerical score that rated pain, function during activity and other measures. At the time of the original injury, the knee also had been scored. At the end of the two years, both groups showed considerable improvement. The scores for the surgically repaired knees had risen by 39.2 points. The scores for the more conservatively treated knees also had risen, by 39.4 points. In other words, the outcomes for the two groups were virtually identical. Despite a widespread belief that surgery leads to a stronger knee, the results showed that surgically reconstructing the A.C.L. as soon as possible after the tear “was not superior” to more conservative treatment, the study’s authors wrote. The findings suggest, the authors concluded, that “more than half the A.C.L. reconstructions” currently being conducted on injured knees “could be avoided without adversely affecting outcomes.”
This possibility should reverberate across playing fields nationwide, where, at the moment, preseason high school, collegiate and adult-league sports practices are under way, with a concomitant surge in A.C.L. tears. By one estimate, as many as 1 in every 556 fit, active people will tear an A.C.L., particularly if they participate in sports that involve frequent pivoting and landing, like soccer, football, tennis, skiing and basketball. At the same time, the urge to treat the injury with surgery appears to be growing. The “belief among most surgeons and patients is that surgery is a ‘must,’ at least if you aim to go back into an active lifestyle,” the Swedish authors of the study wrote in an e-mail response to questions.
Part of the reason for A.C.L. surgery’s popularity is that, by most measures, it works. In the current study, most of the group who had reconstructive surgery reported that their injured knee felt healthy after two years and that they had returned to activity — not, in most cases, at the same level as before their injury, but they were active. Significantly, their knees also were notably more “stable” than the joints that hadn’t been surgically fixed. Stability is, in theory, desirable. A stable knee rarely gives way.
But in practice, the importance of stability after A.C.L. treatment is “controversial,” the New England Journal study’s authors, Richard Frobell, Ph.D., and Stefan Lohmander, M.D., Ph.D., of Lund University, wrote in their e-mail. In an important 2009 study published in the British Journal of Sports Medicine, researchers retrospectively compared outcomes after 10 years in competitive athletes who had surgery or had opted for conservative treatment of their torn A.C.L.’s. The surgically repaired knees were notably more stable. But they weren’t fundamentally healthier. The surgically reconstructed knees and the conservatively treated joints experienced similar (and high) levels of early-onset knee arthritis, a common occurrence after an A.C.L. tear. The treatments were almost identical, too, in terms of whether the athletes could return to sports and whether they reported subsequent knee problems.
Why, then, undergo A.C.L. reconstruction, an operation that can be expensive and, like all surgical procedures, carries risks? Several top-flight orthopedic surgeons I contacted say that they remain convinced that surgery leads to a better long-term outcome for certain patients, particularly if they want to return to pivoting sports. “The reason to have the surgery is to preserve” other parts of the knee from injury during activity, says Dr. Warren Dunn, an assistant professor of orthopedics and rehabilitation at Vanderbilt University who has extensively studied A.C.L. tears. He points out that in the N.E.J.M. study, only 8 percent of the patients in the first surgical group subsequently tore a meniscus, a fragile pillow of cartilage that can rip if a knee gives way. Twenty-five percent of those in the physical therapy group eventually tore their meniscuses.
What these numbers mean for anyone who tears an A.C.L. or is the parent of a young athlete in that situation is that they should have a long, frank conversation with an orthopedic surgeon and possibly also a nonsurgical sports-medicine specialist about options. “We recommend surgery based on activity level and sports,” Dr. Dunn says. “Most subjects can do in-line activities” like running or biking “without an A.C.L.” He adds, “On the other hand, we believe that A.C.L.-deficient subjects that do return” to sports involving cutting, pivoting or planting the leg “can consequently injure the meniscus” or other cartilage in the knee and would benefit from a replacement A.C.L.
The authors of the N.E.J.M. study are less sure. “On the basis of our study results, we’d tell patients” that “there is no apparent downside of starting a good rehab program and waiting with the surgery decision to see if it is needed or not,” the authors wrote to me.
The ultimate lesson of the N.E.J.M. study is almost certainly that more science on the subject is needed. “We definitely know only parts of the long-term outcome” after different A.C.L. treatments, says Dr. Duncan Meuffels, an assistant professor of orthopedic surgery at Erasmus Medical Center in Rotterdam and lead author of the British Journal of Sports Medicine study.
But large-scale, randomized controlled studies, the gold standard of medical research, may be difficult to orchestrate, in part because people with shredded A.C.L.’s can balk at being denied surgery. In the N.E.J.M. study, some of those assigned to physical therapy wound up requesting surgery, although they weren’t experiencing any knee problems. For them, it seems, “the desire to undergo surgery was based on expectations rather than symptoms,” the authors told me. It may be years, unfortunately, before we know if such expectations are justified or if unreconstructed injured knees can be fine.
A new study published late last month in The New England Journal of Medicine is raising provocative questions about how best to treat a torn anterior cruciate ligament. For the study, researchers from Lund University in Sweden recruited 121 young adults who’d injured their A.C.L.’s. The volunteers, between 18 and 35, were physically active, and many were competitive athletes. They agreed, rather bravely, to be randomly assigned to one of two groups and accept radically different treatments for their torn A.C.L.’s. The first group began physical therapy and then underwent surgical reconstruction of the ligament, considered by many people to be the best option for injured athletes. The second group received only physical therapy, with the option to have the operation later. Twenty-three subjects of that group did eventually have the operation. (For those fortunate enough not to be personally familiar with A.C.L. surgery, reconstruction involves replacing the injured ligament with tissue from elsewhere in your own leg or from a cadaver.)
Over two years, the injured knees were assessed using a comprehensive numerical score that rated pain, function during activity and other measures. At the time of the original injury, the knee also had been scored. At the end of the two years, both groups showed considerable improvement. The scores for the surgically repaired knees had risen by 39.2 points. The scores for the more conservatively treated knees also had risen, by 39.4 points. In other words, the outcomes for the two groups were virtually identical. Despite a widespread belief that surgery leads to a stronger knee, the results showed that surgically reconstructing the A.C.L. as soon as possible after the tear “was not superior” to more conservative treatment, the study’s authors wrote. The findings suggest, the authors concluded, that “more than half the A.C.L. reconstructions” currently being conducted on injured knees “could be avoided without adversely affecting outcomes.”
This possibility should reverberate across playing fields nationwide, where, at the moment, preseason high school, collegiate and adult-league sports practices are under way, with a concomitant surge in A.C.L. tears. By one estimate, as many as 1 in every 556 fit, active people will tear an A.C.L., particularly if they participate in sports that involve frequent pivoting and landing, like soccer, football, tennis, skiing and basketball. At the same time, the urge to treat the injury with surgery appears to be growing. The “belief among most surgeons and patients is that surgery is a ‘must,’ at least if you aim to go back into an active lifestyle,” the Swedish authors of the study wrote in an e-mail response to questions.
Part of the reason for A.C.L. surgery’s popularity is that, by most measures, it works. In the current study, most of the group who had reconstructive surgery reported that their injured knee felt healthy after two years and that they had returned to activity — not, in most cases, at the same level as before their injury, but they were active. Significantly, their knees also were notably more “stable” than the joints that hadn’t been surgically fixed. Stability is, in theory, desirable. A stable knee rarely gives way.
But in practice, the importance of stability after A.C.L. treatment is “controversial,” the New England Journal study’s authors, Richard Frobell, Ph.D., and Stefan Lohmander, M.D., Ph.D., of Lund University, wrote in their e-mail. In an important 2009 study published in the British Journal of Sports Medicine, researchers retrospectively compared outcomes after 10 years in competitive athletes who had surgery or had opted for conservative treatment of their torn A.C.L.’s. The surgically repaired knees were notably more stable. But they weren’t fundamentally healthier. The surgically reconstructed knees and the conservatively treated joints experienced similar (and high) levels of early-onset knee arthritis, a common occurrence after an A.C.L. tear. The treatments were almost identical, too, in terms of whether the athletes could return to sports and whether they reported subsequent knee problems.
Why, then, undergo A.C.L. reconstruction, an operation that can be expensive and, like all surgical procedures, carries risks? Several top-flight orthopedic surgeons I contacted say that they remain convinced that surgery leads to a better long-term outcome for certain patients, particularly if they want to return to pivoting sports. “The reason to have the surgery is to preserve” other parts of the knee from injury during activity, says Dr. Warren Dunn, an assistant professor of orthopedics and rehabilitation at Vanderbilt University who has extensively studied A.C.L. tears. He points out that in the N.E.J.M. study, only 8 percent of the patients in the first surgical group subsequently tore a meniscus, a fragile pillow of cartilage that can rip if a knee gives way. Twenty-five percent of those in the physical therapy group eventually tore their meniscuses.
What these numbers mean for anyone who tears an A.C.L. or is the parent of a young athlete in that situation is that they should have a long, frank conversation with an orthopedic surgeon and possibly also a nonsurgical sports-medicine specialist about options. “We recommend surgery based on activity level and sports,” Dr. Dunn says. “Most subjects can do in-line activities” like running or biking “without an A.C.L.” He adds, “On the other hand, we believe that A.C.L.-deficient subjects that do return” to sports involving cutting, pivoting or planting the leg “can consequently injure the meniscus” or other cartilage in the knee and would benefit from a replacement A.C.L.
The authors of the N.E.J.M. study are less sure. “On the basis of our study results, we’d tell patients” that “there is no apparent downside of starting a good rehab program and waiting with the surgery decision to see if it is needed or not,” the authors wrote to me.
The ultimate lesson of the N.E.J.M. study is almost certainly that more science on the subject is needed. “We definitely know only parts of the long-term outcome” after different A.C.L. treatments, says Dr. Duncan Meuffels, an assistant professor of orthopedic surgery at Erasmus Medical Center in Rotterdam and lead author of the British Journal of Sports Medicine study.
But large-scale, randomized controlled studies, the gold standard of medical research, may be difficult to orchestrate, in part because people with shredded A.C.L.’s can balk at being denied surgery. In the N.E.J.M. study, some of those assigned to physical therapy wound up requesting surgery, although they weren’t experiencing any knee problems. For them, it seems, “the desire to undergo surgery was based on expectations rather than symptoms,” the authors told me. It may be years, unfortunately, before we know if such expectations are justified or if unreconstructed injured knees can be fine.
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