Dr. Jeff Abrams
Princeton, New Jersey

Nobody knows whether the lack of surgery is a direct path to DJD. However, other injuries including meniscal tears and chondral injuries can occur following repeat subluxation, which can lead to premature degenerative conditions.

F. Alan Barber MD, FACS
Plano, Texas

The loss of the meniscus cartilage and severe damage to the weight bearing articular cartilage lead to the knee wearing out. Some damage to the weight-bearing cartilage usually occurs with ACL tears, but I believe that they will heal with time. If you avoid pivoting sports, or if your knee is stabilized surgically so that you do not have buckling episodes, there is a good chance that your knee will not wear out early even if you do not have the ACL fixed. If, however, you continue to have buckling episodes, your meniscus cartilages are very likely to tear, a condition which can lead to arthritis.

Dr. Don Johnson
Ottawa, Canada

More damage to the articular surface, or 'wearing out,' will occur if the knee continues to give way. Giving way should be prevented by activity modification, bracing, or surgical reconstruction. Don Shelbourne, MD, has shown that if the ACL tear is isolated, and there is no meniscal or cartilage damage at the time of the original surgery, the x-ray of the knee will be normal in 97% of the cases. This means that athletes who have a reconstruction and continue to be active can have a normal knee after 10 years.

Dr. Hugh West
Salt Lake City, Utah

Additional damage to the surface cartilage inside the knee happens when the knee gives out because it is unstable after an ACL injury. Everyone who has an unstable knee knows it. If your knee is loose and gives out frequently, then you probably know that your are damaging it. If your knee feels stable, even after an ACL injury, then it is unlikely that your knee will wear out much faster than normal. However, if your knee gives out frequently, then common sense will tell you that you are hurting the cartilage inside the knee, a condition which will lead to early arthritis.