Q: Last year I tore my ACL during a soccer match. An anthroscopy operation was performed on my knee, which was followed by 6 weeks of physiotherapy in order to regain full motion and strength of the knee. A knee specialist told me that my knee would probably buckle every now and then, which is not a pleasant experience. With respect to this, it was agreed that I would be put on one year waiting list to have a patellar tendon graft procedure. One year passed and I am due for operation. However, my knee has not buckled once and I can jog and perform gym exercises comfortably. Furthermore my job doesn't require any particular physical activity. The only activity, I would like to start is the occasional game of soccer, maybe twice a month. Is playing soccer at all possible in my current state, i.e. without having the operation? Would you advise surgery just to be able to play soccer when all else is already ok?

A:Your dilemma is quite understandable. Anterior cruciate ligament (ACL) is a major stabilising ligament of the knee. When this is torn the body can compensate very well provided the patient has good quadriceps (front of thigh muscles) and good hamstrings (back of thigh muscles). Patients who have only an ACL tear may be able to get away with most activities with the compensation provided by the muscles. However, there will be some critical activity based on stress tolerance where the knee will buckle in certain positions. Usually in contacts sports like football the probably of this event happening is high. Therefore, though you may get away with a possible friendly match without any problem where as in the heat of a well-fought match you may stress beyond your limits causing the knee to buckle with associated pain and swelling. Every such episode weakens the knee further and therefore, my recommendation is you will have to choose between your knee and your love for soccer. Till about almost two decades back most patients were being advised only exercises to build up the muscles. However, with the advent of arthroscopic surgery on a wider scale, more and more patients are being taken up for this surgery. In experienced hands this is a reasonably safe surgery and it does provide sufficient stability to allow you to play soccer. You may or may not notice much difference if you have a light sedentary occupation. The surgery does have (like any surgery) its share of side effects and complications. These could include stiffness of the knee, some persistence of instability; occasional patient may have recurrence, or effusion in the knee. Some of these patients may also have pain at the site of screw insertion or anchoring of the tendons used for reconstruction. These patients are likely to be unhappy. However, if you decide to get it done my suggestion would be that it should be done by somebody who does this regularly and not occasionally. I hope you will be able to make a decision based on these suggestions.