ACL Injury Prevention

« Newer Posts

Knee Repair? Study finds PT as good as surgery for torn cartilage, arthritis

By Tiffany Coletta

Knee repair? Study finds physical therapy as good as surgery for torn cartilage, arthritis. 

  • Article by: MARLYNN MARCHIONE , Associated Press
  • Updated: March 19, 2013 – 11:52 AM
  • Published in the Minneapolis Star Tribune
  • Photo: Jennifer Simonson, Star Tribune

You might not want to rush into knee surgery. Physical therapy can be just as good for a common injury and at far less cost and risk, the most rigorous study to compare these treatments concludes.

Therapy didn’t always help and some people wound up having surgery for the problem, called a torn meniscus. But those who stuck with therapy had improved as much six months and one year later as those who were given arthroscopic surgery right away, researchers found.

“Both are very good choices. It would be quite reasonable to try physical therapy first because the chances are quite good that you’ll do quite well,” said one study leader, Dr. Jeffrey Katz, a joint specialist at Brigham and Women’s Hospital and Harvard Medical School.

He was to discuss the study Tuesday at an American Academy of Orthopaedic Surgeons conference in Chicago. Results were published online by the New England Journal of Medicine.

A meniscus is one of the crescent-shaped cartilage discs that cushion the knee. About one-third of people over 50 have a tear in one, and arthritis makes this more likely. Usually the tear doesn’t cause symptoms but it can be painful.

When that happens, it’s tough to tell if the pain is from the tear or the arthritis — or whether surgery is needed or will help. Nearly half a million knee surgeries for a torn meniscus are done each year in the U.S.

The new federally funded study compared surgery with a less drastic option. Researchers at seven major universities and orthopedic surgery centers around the U.S. assigned 351 people with arthritis and meniscus tears to get either surgery or physical therapy. The therapy was nine sessions on average plus exercises to do at home, which experts say is key to success.

After six months, both groups had similar rates of functional improvement. Pain scores also were similar.

Thirty percent of patients assigned to physical therapy wound up having surgery before the six months was up, often because they felt therapy wasn’t helping them. Yet they ended up the same as those who got surgery right away, as well as the rest of the physical therapy group who stuck with it and avoided having an operation.

“There are patients who would like to get better in a `fix me’ approach” and surgery may be best for them, said Elena Losina, another study leader from Brigham and Women’s Hospital.

However, an Australian preventive medicine expert contends that the study’s results should change practice. Therapy “is a reasonable first strategy, with surgery reserved for the minority who don’t have improvement,” Rachelle Buchbinder of Monash University in Melbourne wrote in a commentary in the medical journal.

As it is now, “millions of people are being exposed to potential risks associated with a treatment that may or may not offer specific benefit, and the costs are substantial,” she wrote.

Surgery costs about $5,000, compared with $1,000 to $2,000 for a typical course of physical therapy, Katz said.

One study participant — Bob O’Keefe, 68, of suburban Boston — was glad to avoid surgery for his meniscus injury three years ago.

“I felt better within two weeks” on physical therapy, he said. “My knee is virtually normal today” and he still does the recommended exercises several times a week.

Robert Dvorkin had both treatments for injuries on each knee several years apart. Dvorkin, 56, director of operations at the Coalition for the Homeless in New York City, had surgery followed by physical therapy for a tear in his right knee and said it was months before he felt no pain.

Then several years ago he hurt his left knee while exercising. “I had been doing some stretching and doing some push-ups and I just felt it go `pop.'” he recalls. “I was limping, it was extremely painful.”

An imaging test showed a less severe tear and a different surgeon recommended physical therapy. Dvorkin said it worked like a charm — he avoided surgery and recovered faster than from his first injury. The treatment involved two to three hour-long sessions a week, including strengthening exercises, balancing and massage. He said the sessions weren’t that painful and his knee felt better after each one.

“Within a month I was healed,” Dvorkin said. “I was completely back to normal.”


AP Medical Writer Lindsey Tanner in Chicago contributed to this report.


Marilynn Marchione can be followed on Twitter at

Lindsey Tanner can be followed on Twitter at

Ski/Ride Strong: An ACL/Knee Injury Prevention and Performance Program

By Tiffany Coletta

A collaborative class offering from:

Excel PT HealthBalance

“Ski/Ride Strong: An ACL/Knee Injury Prevention & Performance Program”

October 11 – November 17, 2011

Tuesdays & Thursdays 6:30-7:30pm

at HealthBalance, 2030 Stadium Drive, Bozeman

12 evening sessions ~ Cost: $300

Class Size is Limited to 15 Participants

This 12 session program is aimed at decreasing the incidence of skier/snowboarder injuries and improving sport performance.  Anterior Cruciate Ligament (ACL) injuries of the knee are relatively common in skiing.  In addition to putting you out for the season, they are costly: the cost of an ACL injury per athlete is approximately $17,000 (including surgery and rehabilitation).

Injury prevention programs focusing on strengthening, agility, jumping and landing, all with the emphasis on learning proper technique, have been shown to be effective in reducing non-contact ACL injuries.

Prevent costly common lower extremity injuries in skiing & snowboarding while improving your skiing/snowboarding performance. This comprehensive program will help you learn how to cut, pivot, jump and land with proper technique utilizing the latest sports medicine research on injury prevention to keep you on the mountain as well as the latest human performance equipment to track your improvement.

Under the direction of Excel Physical Therapy’s sports physical therapist, Jason Lunden, DPT, SCS and HealthBalance’s exercise physiologist, Eddie Davila, MS, HFS, you will receive advanced sports-oriented training to improve your skiing/snowboarding strength, endurance, agility, coordination, and speed.

Hurry! Register by October 4th

Space limited to the first 15 registrants

Contact HealthBalance @ 406.922.2078 or email:

ACL Injury Prevention for Snowboarders

By Jason Lunden, DPT, SCS

Knee injuries, more specifically Anterior Cruciate Ligament (ACL) tears, are much less common in snowboarding than in alpine skiing.  However, an ACL injury is a season-ending injury and the most common injury requiring surgery in snowboarding.  ACL injuries are more prevalent in advanced/expert level snowboarders and are most often the result of a fall after a jump.  The mechanism of injury for ACL tears in snowboarding is different from alpine skiing.  ACL tears in snowboarding are thought to be due to a “quadriceps induced” injury, where there is an imbalance between the quadriceps and hamstrings.  This can occur when you land flat off of a jump without much of a bend in the knee.  Therefore, properly scoping out the landing before hitting a jump or a cliff, as well as adding hamstring strengthening to your dry-land training can go a long ways in preventing ACL injuries in snowboarding.  Additionally, undergoing jump and landing retraining with a licensed physical therapist can further prevent injury.

For additional ACL Injury Prevention Exercises, Click here: ski & snowboard ACL injury prevent exercises

"I appreciate Megan always running on schedule (In addition to everything else!)" --L.T., Bozeman client

View more testimonials from Excel PT clients »