Medical Forum
No 'one size fits all' approach to ACL – what GPs need to know
Taking a patient-centred approach that considers their needs and desired outcomes is the best way to approach ACL injuries.
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Medical Forum
That’s what orthopaedic surgeon Dr Jean-Louis Papineau wants GPs to know when they are working with these injuries.
Anterior cruciate ligament (ACL) injuries are common in Australia and GPs are often a patient's first port of call when it comes to pain and injuries.
We’re a nation that loves our sport, but the sudden movement of some of our favourite games – think football, netball and soccer – can cause a tear or sprain to the ligament.
When it comes to management, Dr Papineau said there is no right or wrong answer.
“It’s a nuanced management. What is quite important is having everybody on board, having a patient who is fully engaged in the treatment decision, understanding what they want out of the immediate and future, and having the whole treating team – the physio, surgeon, GP – on board to achieve that goal.”
Dr Papineau will be addressing this, ACL re-ruptures and factors that lead to repeat injuries at a Coastal Orthopaedics GP education event in August.
As is the case with many different injuries and ailments, a multidisciplinary approach often works best.
“It does need quite an involved approach with a few different groups,” Dr Papineau told Medical Forum.
“It requires having a chat with the patient and working out what’s best for them.
“It’s good to have that discussion early to let the patient know that surgery is not the only option by any stretch, but you want to have the options presented early and for that person to make the most informed decision.
“What is appropriate for one person may not be appropriate for the next.”
While surgery is also no longer the only option and some patients see success with physiotherapy, Dr Papineau cautioned that all patients must be followed up in the same way so additional injuries are not overlooked.
“For example, if someone has a minor degree of instability that adds up over 12 months of return to play and they end up with a cartilage injury or meniscal tear but we were never following that person up because it was thought to be successful non-operative treatment, then we see them too late with a bigger injury.”
Secondary injuries
A patient may come to you with an ACL injury, but it’s important not to rule out additional injuries, Dr Papineau added.
“The things I really worry about are concurrent injuries with an ACL,” he said.
“The ACL in and of itself is not a huge issue and we can manage that, but when you start to get large chondral lesions or meniscal tears, if we don’t get early referrals the window for treating that before other problems set in closes.
“I don’t really want to see an ACL and a meniscal tear six months later because I may not be fixing that meniscus knowing that person is now going to end up with arthritis.”
If they have an ACL injury plus anything else, then I would encourage early conversation with someone who can appropriately guide that patient.
Coastal Orthopaedics 'Practical Orthopaedics for GPs' event will be held on August 8 at Bethesda Hospital, from 8am to 1pm.
The GP education event covers common acute and chronic orthopaedic presentations. Dr Jean-Louis Papineau and colleagues will be presenting case studies and discussing common presentations to general practice.
More information or booking your free spot is available here.