Surgery is the default treatment for ACL injuries in Australia. But it’s not the only way
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The anterior cruciate ligament (ACL) is an important ligament in the knee. It runs from the thigh bone (femur) to the shin bone (tibia) and helps stabilise the knee joint.
Injuries to the ACL, often called a “tear” or a “rupture”, are common in sport. While a ruptured ACL has just sidelined another Matildas star, people who play sport recreationally are also at risk of this injury.
For decades, surgical repair of an ACL injury, called a reconstruction, has been the primary treatment in Australia. In fact, Australia has among the highest rates of ACL surgery in the world. Reports indicate 90% of people who rupture their ACL go under the knife.
Although surgery is common – around one million are performed worldwide each year – and seems to be the default treatment for ACL injuries in Australia, it may not be required for everyone.
What does the research say?
We know ACL ruptures can be treated using reconstructive surgery, but research continues to suggest they can also be treated with rehabilitation alone for many people.
Almost 15 years ago a randomised clinical trial published in the New England Journal of Medicine compared early surgery to rehabilitation with the option of delayed surgery in young active adults with an ACL injury. Over half of people in the rehabilitation group did not end up having surgery. After five years, knee function did not differ between treatment groups.
The findings of this initial trial have been supported by more research since. A review of three trials published in 2022 found delaying surgery and trialling rehabilitation leads to similar outcomes to early surgery.
A 2023 study followed up patients who received rehabilitation without surgery. It showed one in three had evidence of ACL healing on an MRI after two years. There was also evidence of improved knee-related quality of life in those with signs of ACL healing compared to those whose ACL did not show signs of healing.
Regardless of treatment choice the rehabilitation process following ACL rupture is lengthy. It usually involves a minimum of nine months of progressive rehabilitation performed a few days per week. The length of time for rehabilitation may be slightly shorter in those not undergoing surgery, but more research is needed in this area.
Rehabilitation starts with a physiotherapist overseeing simple exercises right through to resistance exercises and dynamic movements such as jumping, hopping and agility drills.
A person can start rehabilitation with the option of having surgery later if the knee remains unstable. A common sign of instability is the knee giving way when changing direction while running or playing sports.
To rehab and wait, or to go straight under the knife?
There are a number of reasons patients and clinicians may opt for early surgical reconstruction.
For elite athletes, a key consideration is returning to sport as soon as possible. As surgery is a well established method, athletes (such as Matilda Sam Kerr) often opt for early surgical reconstruction as this gives them a more predictable timeline for recovery.
At the same time, there are risks to consider when rushing back to sport after ACL reconstruction. Re-injury of the ACL is very common. For every month return to sport is delayed until nine months after ACL reconstruction, the rate of knee re-injury is reduced by 51%.
Historically, another reason for having early surgical reconstruction was to reduce the risk of future knee osteoarthritis, which increases following an ACL injury. But a review showed ACL reconstruction doesn’t reduce the risk of knee osteoarthritis in the long term compared with non-surgical treatment.
That said, there’s a need for more high-quality, long-term studies to give us a better understanding of how knee osteoarthritis risk is influenced by different treatments.
Rehab may not be the only non-surgical option
Last year, a study looking at 80 people fitted with a specialised knee brace for 12 weeks found 90% had evidence of ACL healing on their follow-up MRI.
People with more ACL healing on the three-month MRI reported better outcomes at 12 months, including higher rates of returning to their pre-injury level of sport and better knee function. Although promising, we now need comparative research to evaluate whether this method can achieve similar results to surgery.
What to do if you rupture your ACL
First, it’s important to seek a comprehensive medical assessment from either a sports physiotherapist, sports physician or orthopaedic surgeon. ACL injuries can also have associated injuries to surrounding ligaments and cartilage which may influence treatment decisions.
In terms of treatment, discuss with your clinician the pros and cons of management options and whether surgery is necessary. Often, patients don’t know not having surgery is an option.
Surgery appears to be necessary for some people to achieve a stable knee. But it may not be necessary in every case, so many patients may wish to try rehabilitation in the first instance where appropriate.
As always, prevention is key. Research has shown more than half of ACL injuries can be prevented by incorporating prevention strategies. This involves performing specific exercises to strengthen muscles in the legs, and improve movement control and landing technique.
Anthony Nasser, Senior Lecturer in Physiotherapy, University of Technology Sydney; Joshua Pate, Senior Lecturer in Physiotherapy, University of Technology Sydney, and Peter Stubbs, Senior Lecturer in Physiotherapy, University of Technology Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Loving Life at 50+ – by Maria Sabando
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What a pleasant mix of a book! Sabando writes about aging with a great blend of light-heartedness and seriousness, and gives extra attention to the important balancing act of:
- Indulging sufficiently to enjoy life
- Staying well enough to enjoy life
…because one without the other will not generally result in an enjoyable life! An American proud of her Italian heritage, she blends (as many immigrant families do) cultures and perspectives, aiming where she can for “the best of both” in that regard, too.
Nor is this just a philosophical book—there’s yoga to be learned here, chapter by chapter, and recipes peppered throughout. The recipes, by the way, are simple and… Honestly, not as healthy as the recipes we share here at 10almonds, but they are good and when it comes to those indulgences we mentioned, her philosophy is that strategic mindful indulgence keeps mindless binge-eating at bay. Which is generally speaking not a bad approach, and is one we’ve written about before as well.
When it comes to health advice, the author is no doctor or scientist, but her husband (a doctor) had input throughout, keeping things on track and medically sound.
The style is very casual, like talking to a friend, which makes for a very easy and enjoyable read. Absolutely a book that one could read casually in the garden, put down when interrupted, pick up again, and continue happily where one left off.
Bottom line: whatever your age (no matter whether your 50th birthday is in your shrinkingly near future or your increasingly distant past), there’s wisdom to be gained here—it’s not a manual (unless you want to treat it as one), it’s more… Thought-provoking, from cover to cover. Highly recommendable.
Click here to check out Loving Life at 50+, and love life at 50+!
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Pistachios vs Almonds – Which is Healthier?
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Our Verdict
When comparing pistachios to almonds, we picked the almonds.
Why?
It was very close! And those who’ve been following our “This or That” comparisons might be aware that pistachios and almonds have both been winning their respective comparisons with other nuts so far, so today we put them head-to-head.
In terms of macros, almonds have a little more protein and a little more fiber—as well as slightly more fat, though the fats are healthy. Pistachios, meanwhile, are higher in carbs. A moderate win for almonds on the macro front.
When it comes to vitamins, pistachios have more of vitamins A, B1, and B6, while almonds have more of vitamins B2, B3, and E. We could claim a slight victory for pistachios, based on the larger margins, or else a slight victory for almonds, based on vitamin E being a more common nutritional deficiency than vitamin A, and therefore the more useful vitamin to have more of. We’re going to call this category a tie.
In the category of minerals, almonds lead with more calcium, magnesium, manganese, and zinc, while pistachios boast more copper, potassium, and selenium, though the margins are more modest for pistachios. A moderate win for almonds on minerals, therefore.
Adding up the sections gives a win for almonds, but of course, do enjoy both, because both are excellent in their own right.
Want to learn more?
You might like to read:
- Why You Should Diversify Your Nuts!
- Pistachios vs Walnuts – Which is Healthier?
- Almonds vs Cashews – Which is Healthier?
Take care!
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Exercise and Fat Loss (5 Things You Need To Know)
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It’s easy to think “I’ll eat whatever; I can always burn it off later”, and if it’s an odd occasion, then that’s fine; indeed, a fit and healthy body can usually weather small infrequent dietary indiscretions easily. But…
You can’t outrun a bad diet
Exercise can create a calorie deficit, but over time, the body balances this out by adjusting one’s metabolism, leading to a plateau in fat loss—and as you might know, you can’t out-exercise a bad diet. On the contrary, dietary adjustments are crucial for fat loss and body recomposition.
About that calorie deficit in the first place, by the way: extreme calorie deficits through exercise alone can lead to muscle loss, reduced energy, and thus sabotage long-term fat loss because having muscle mass increases one’s base metabolic rate (while having fat does not).
Another thing to bear in mind about exercise is that longer workouts without adequate rests in between can cause burnout, injury, or weight gain due to the body doing its best to conserve energy.
So, a good diet is a necessary condition for both muscle maintenance and fat loss.
Five Key Diet Tips:
- Include foods you love: don’t feel obliged cut out favorite foods that are a little unhealthy; incorporate them in moderation for sustainability.
- Keep adjustments small: avoid making drastic dietary changes all at once; make gradual tweaks to prevent feeling deprived.
- Prioritize protein: focus on including a protein source in every meal to increase satiety and aid in muscle building.
- Avoid low-calorie diets: drastically cutting calories can lead to muscle loss, metabolic adaptation, and overeating.
- Embrace diet evolution: changes may not feel sustainable at first, but adjustments over time help achieve long-term balance. You can always “adjust course” as you go.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Are You A Calorie-Burning Machine?
Take care!
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Tasty Versatile Rice
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In the nearish future, we’re going to do some incredible rice dishes, but first we need to make sure we’re all on the same page about cooking rice, so here’s a simple recipe first, to get technique down and work in some essentials. We’ll be using wholegrain basmati rice, because it has a low glycemic index, lowest likelihood of heavy metal contamination (a problem for some kinds of rice), and it’s one of the easiest rices to cook well.
You will need
- 1 cup wholegrain basmati rice (it may also be called “brown basmati rice“; this is the same)
- 1 1/2 cups vegetable stock (ideally you have made this yourself from vegetable offcuts that you saved in the freezer, then it will be healthiest and lowest in sodium; failing that, low-sodium vegetable stock cubes can be purchased at most large supermarkets. and then made up at home with hot water)
- 1 tbsp extra virgin olive oil
- 1 tbsp chia seeds
- 1 tbsp black pepper, coarse ground
- 1 tsp turmeric powder (this small quantity will not change the flavor, but it has important health benefits, and also makes the rice a pleasant golden color)
- 1 tsp garlic powder
- 1 tsp yeast extract (this gently improves the savory flavor and also adds vitamin B12)
- Optional small quantity of green herbs for garnish. Cilantro is good (unless you have the soap gene); parsley never fails.
This is the ingredients list for a super-basic rice that will go with anything rice will go with; another day we can talk more extensive mixes of herbs and spice blends for different kinds of dishes (and different health benefits!), but for now, let’s get going!
Method
(we suggest you read everything at least once before doing anything)
1) Wash the rice thoroughly. We recommend using a made-for-purpose rice-washing bowl (like this one, for example), but failing that, simply rinse it thoroughly with cold water using a bowl and a sieve. You will probably need to rinse it 4–5 times, but with practice, it will only take a few seconds per rinse, and the water will be coming up clear.
2) Warm the pan. It doesn’t matter for the moment whether you’re using an electronic rice cooker, a stovetop pressure cooker, electronic pressure cooker, or just a sturdy pan with a heavy lid available, aside from that if it’s something non-stovetop, you now want it to be on low to warm up already.
3) Separately in a saucepan, bring your stock to a simmer
4) Put the tbsp of olive oil into the pan (even if you’re confident the rice won’t stick; this isn’t entirely about that) and turn up the heat (if it’s a very simple rice cooker, most at least have a warm/cook differentiation; if so, turn it to “cook”). You don’t want the oil to get to the point of smoking, so, to test the temperature as it heats, flick a single drop of water from your fingertip (you did wash your hands first, right? We haven’t been including that step, but please do wash your hands before doing kitchen things) into the pan. If it sizzles, the pan is hot enough now for the next step.
5) Put the rice into the pan. That’s right, with no extra liquid yet; we’re going to toast it for a moment. Stir it a little, for no more than a minute; keep it moving; don’t let it burn! If you try this several times and fail, it could be that you need a better pan. Treat yourself to one when you get the opportunity; until then, skip the toasting part if necessary.
6) Add the chia seeds and spices, followed by the stock, followed by the yeast extract. Why did we do the stock before the yeast extract? It’s because hot liquid will get all the yeast extract off the teaspoon 🙂
7) Put the lid on/down (per what kind of pan or rice cooker you are using), and turn up the heat (if it is a variable heat source) until a tiny bit of steam starts making its way out. When it does, turn it down to a simmer, and let the rice cook. Don’t stir it, don’t jiggle it; trust the process. If you stir or jiggle it, the rice will cook unevenly and, paradoxically, probably stick.
8) Do keep an eye on it, because when steam stops coming out, it is done, and needs taking off the heat immediately. If using an automatic rice cooker, you can be less attentive if you like, because it will monitor this for you.
Note: if you are using a simple pan with a non-fastening lid (any other kind of rice cooking setup is better), more steam will escape than the other methods, and it’s possible that it might run out of steam (literally) before the rice is finished. If the steam stops and you find the rice isn’t done, add a splash of water as necessary (the rice doesn’t need to be submerged, it just needs to have liquid; the steam is part of the cooking process), and make a note of how much you had to add (so that next time you can just add it at the start), and put it back on the heat until it is done.
9) Having taken it off the heat, let it sit for 5 minutes (with the lid still on) before doing any fluffing-up. Then you can fluff-up and serve, adding the garnish if you want one.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Should You Go Light Or Heavy On Carbs?
- Chia: The Tiniest Seeds With The Most Value
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Why Curcumin (Turmeric) Is Worth Its Weight In Gold
- The Many Health Benefits Of Garlic
Take care!
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The Knowledge That Harvard Medical School’s Clinical Instructor Dr. Monique Tello Thinks Everyone SHOULD Have About Heart Health
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Anyone (who has not had a double mastectomy, anyway) can get breast cancer.
Breast cancer, if diagnosed early (before it spreads), has a 98% survival rate.
That survival rate drops to 31% if diagnosed after it has spread through the body.
(The US CDC’s breast cancer “stat bite” page has more stats and interactive graphs, so click here to see those charts and get the more detailed low-down on mortality/survival rates with various different situations)
We think that the difference between 98% and 31% survival rates is more than enough reason to give ourselves a monthly self-check at the very least! You’ve probably seen how-to diagrams before, but here are instructions for your convenience:
This graphic created by the Jordan Breast Cancer Program (check them out, as they have lots of resources)
If you don’t have the opportunity to take matters into your own hands right now, rather than just promise yourself “I’ll do that later”, take this free 4-minute Breast Health Assessment from Aurora Healthcare. Again, we think the difference early diagnosis can make to your survival chances make these tests well worth it.
Lest we forget, men can also get breast cancer (the CDC has a page for men too), especially if over 50. But how do you check for breast cancer, when you don’t have breasts in the commonly-understood sense of the word?
So take a moment to do this (yes, really actually do it!), and set a reminder in your calendar to repeat it monthly—there really is no reason not to! Take care of yourself; you’re important.
Pssst! Did you scroll past the diagrams, looking for the online 4-minute test promised by the subtitle? If so, scroll back up; the link is in the middle!
Harvard Medical School’s Clinical Instructor’s Five-Point Plan for Heart Health
Dr. Monique Tello, M.D., M.P.H., is a practicing physician at Massachusetts General Hospital, director of research and academic affairs for the MGH DGM Healthy Lifestyle Program, clinical instructor at Harvard Medical School, and author of the evidence-based lifestyle change guide Healthy Habits for Your Heart.
Here are what she says are the five most important factors to help keep your ticker ticking:
5. Have (at most) a moderate alcohol intake! While there are polyphenols such as resveratrol in red wine that could boost heart health, there’s so little per glass that you may need 100–1000 glasses to get the dosage that provides benefits in mouse studies. If you’re not a mouse, it may not be as beneficial, and Dr. Tello recommends drinking no more than one glass per day of any alcohol. What constitutes a glass? It varies from one kind of drink to another, so here’s a handy guide.
4. Don’t smoke. Best of all to never start. But if you did, quit. Simple as that. There is no healthy amount of smoking. While paradoxically, quitting smoking may of course be stressful to you, the long term gains are considered more than worth it. As with all advice, do consult your own physician for guidance, as individual circumstances may vary, and that may change the best approach for you.
3. Maintain a healthy body weight. While BMI (Body Mass Index) is not a perfect system, it’s a system in popular use, and Dr. Tello recommends keeping a BMI between 18.5 and 24.9.
What’s your BMI? It takes into account your height and weight; here’s a Quick BMI Calculator for your convenience.
2. Keep a healthy level of physical activity—which ideally means at least 30 minutes per day vigorous activity, but obviously if you’re not used to this, take it slowly and build up over time. Even just small lifestyle changes (walking where possible, taking the stairs instead of the elevator where possible, etc) can add up to a big difference.
1. Enjoy a healthy diet. This is the single most important thing, and the best modern scientific consensus holds that the best diet contains plenty of vegetables, fruits and nuts, whole grains, and omega-3 fatty acids, while it avoids processed meats, sugar-sweetened beverages, trans fats (what are trans fats?), and too much sodium.
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As The Summer Gets Hotter Still…
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I would love to see an article about heat dehydrated illness….so much of the US is under hot conditions. I had an fainting sweating episode and now trying to recoup from it. What should we do? Drink water,rest…???❞
We have done some of this, but it’s always a good one to revisit! Last summer (N. Hemisphere summer), we wrote this:
Stay Safe From Heat Exhaustion & Heatstroke!
…and this year, it’s getting hotter still (and is already the hottest summer on record), with certainly much of the US seriously affected, as you say. Next year, it will probably be worse again; climate change is getting predictable like that, and likely will continue until fixed. We are but a health science publication, so we can’t fix the world’s climate, but we can reiterate the above advice, and urge everyone to take it seriously.
Note: heat exhaustion and heatstroke kill. Yes, we’re including heat exhaustion in that, because by the time you get heat exhaustion, you’re often not in the best state of mind to take the correct steps to avoid the heatstroke that follows.
To think otherwise would be akin to thinking “falling never killed anyone; it’s only when you stop falling that it’s dangerous”.
This summer, we did also write this more niche article:
…whose advice won’t apply to everyone, but will be helpful to some, and honestly, some of that advice does go for everyone.
One thing we didn’t write about in those articles that we’ll add here:
Humidity is dangerous:
- Dry heat: you sweat, the sweat evaporates, cooling you. As well as losing heat, you’ve also now lost water and salts, which you’ll need to replenish, but your body is operating correctly.
- Humid heat: you sweat, and now you are just sweaty until further notice. It doesn’t evaporate because the surrounding humidity doesn’t provide the physics for that. Not only are you not losing heat through evaporating sweat, but also, if you’re wearing clothes, that’s now an insulating layer you’re wearing.
…so that means, watch the humidity as carefully as you watch the temperature, and when it’s high, get extra serious about finding ways to keep yourself cool (e.g. shade, rest, cooling showers etc if you can, that kind of thing).
Take care!
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