How Do You Manage the Patient Who Has Early Degenerative Joint Disease and Has Complaints of Pain and Instability?
First of all, the incidence and risk of degenerative joint disease of the anterior cruciate ligament (ACL)-deficient knee is significant, particularly with concomitant injury to the menisci and articular cartilage. In addition, a patient with predisposing factors such as preexisting varus alignment of the knee and who suffers ACL disruption may be at increased risk due to loss of some neuromuscular control of the knee.1 This loss of control allows the knee to go into a little bit more varus and, therefore, overload the medial compartment with a higher risk of chronic medial compartment overload and degeneration. The ACL does provide neuromuscular feedback and mechanically does provide some varus control of the knee. Therefore, with chronic ACL instability, the development of further varus deformity will often result in further medial compartment overload. As a result, it is not uncommon to encounter patients who have early degenerative joint disease complaining of medial joint pain and overload as well as instability in the setting of ACL deficiency.
