What researchers want to know is this: Why do these injuries precipitate arthritis?
Is the answer a bone bruise that injures cartilage? Chemical changes that happen as the body tries to repair the injury? An intrinsic instability of the knee?
And would surgical methods that more closely reproduce an individual’s original knee anatomy reduce the risk?
“Most young athletes just want to focus on the problem at hand,” he said. “Yesterday in my office, I saw a 17-year-old soccer player. ‘Yes, you tore your A.C.L.’ The tears start to come. It is hard to talk to a 17-year-old about what their knee will be like in 20 years.”
Lalli’s arthritis progressed despite his receiving a second A.C.L. reconstruction that was more tailored to the anatomy of his knee. His initial operation had been done by a surgeon who did not position the new ligament in the exact place it had been before.
Lalli had the subsequent operation done by Dr. Freddie Fu, the chairman of the Department of Orthopedic Surgery at the University of Pittsburgh School of Medicine. Fu is a leader in A.C.L. operations that are more anatomically specific, and his procedure stabilized Lalli’s knee. Nonetheless, Lalli has faced years of disabling pain.
Four years ago, when his arthritis got so bad that he gave up playing soccer, Lalli asked for a knee replacement. Fu refused, telling him that artificial knees last only 10 or 15 years in younger and active people and that each knee replacement is more problematic than the one before.
A person can have only two or three knee replacements in a lifetime, Fu told Lalli, and so it was best to wait until he was 50.
Now Lalli is trying to decide whether to let his children play soccer. He has a 5-year-old and 3-year-old twins, and he said they “seem to naturally gravitate toward soccer.”
Lalli, who loves the sport, is torn and has been talking it over with his wife.
“I’m not sure what we will do,” he said.