A torn anterior cruciate ligament (ACL) is one of the most common and debilitating knee injuries, with an estimated 200,000 injuries per year. ACL reconstruction is a common treatment strategy, with many patients wishing to return to sport. But with the advancement of orthopaedic surgery and fixation devices, several new ACL repair procedures have developed.

So, is reconstruction always necessary and what does the latest research say about the long-term outcomes of each approach?

ACL reconstruction and ACL repair

ACL reconstruction involves replacing the torn ligament with a graft, usually taken from the patient’s own hamstring or patellar tendon. This graft acts as a new ligament, gradually incorporating into the knee and restoring stability. It has been the gold standard treatment for decades, supported by consistent evidence of excellent long-term outcomes.

ACL repair, on the other hand, aims to preserve the existing ligament by reattaching it to the bone and sometimes reinforcing it with an internal brace or scaffold. In theory, this approach allows for faster early recovery and maintains native tissue. However, it’s only suitable for specific types of tears, typically where the ligament has detached cleanly from the bone.

In recent years, several new repair techniques have been developed with advances in new fixation devices, and so far, arthroscopic ACL repair has reported promising results. Nevertheless, reconstruction remains the gold standard and ACL repair still needs further research.

What the latest research shows

A 2024 meta-analysis published in the Orthopaedic Journal of Sports Medicine compared modern augmented ACL repair techniques with traditional ACL reconstruction. The review found that ACL repair offered certain short-term benefits, such as stronger early hamstring function and slightly higher Lysholm scores (a common measure of knee recovery). These findings suggest that patients may feel stronger and more mobile in the early months following repair.

However, the same analysis revealed a higher rate of re-rupture and reoperation in the repair group compared to reconstruction. Over a two- to five-year follow-up period, repairs were more likely to fail, often requiring subsequent revision surgery. Reconstruction, while involving a longer recovery initially, provided greater long-term joint stability and lower failure rates overall.

So, while ACL repair can be appropriate in select cases, ACL reconstruction remains the most reliable option for restoring stability and protecting the knee from future injury.

Why reconstruction remains the gold standard

The ACL plays a vital role in knee stability, especially during twisting, pivoting, or rapid directional changes. When the ligament is completely torn, the knee becomes prone to giving way, increasing the risk of damage to other structures such as the meniscus and cartilage. Without a stable joint, patients may also be at higher risk of developing early osteoarthritis.

Reconstruction restores this mechanical stability by creating a robust, graft-based ligament that mimics the natural ACL. Although the rehabilitation process typically takes six to nine months, the outcomes are highly predictable, with most patients regaining full strength and confidence to return to sport or physical activity.

Modern arthroscopic techniques have also made reconstruction less invasive than in the past. Smaller incisions, improved graft fixation, and more tailored rehabilitation programmes mean faster recovery times and lower complication rates than ever before.

Choosing the right approach

When deciding on treatment, several factors come into play such as age, activity level, tear pattern, and personal goals. Younger, athletic patients or those who participate in pivoting sports such as football, netball, or skiing, usually benefit most from ACL reconstruction. For these patients, joint stability is crucial to both performance and long-term joint protection.

If you’ve sustained an ACL injury and are unsure about your options, it’s important to seek advice from a knee specialist. A detailed assessment, including MRI imaging and a review of your activity goals, will help determine the most appropriate treatment.

Older patients who do not participate in high intensity pivoting sports may regain sufficient stability through physiotherapy and still return to an active lifestyle.

For most patients, ACL reconstruction offers the best combination of stability, reliability, and protection for the future, allowing a safe return to sport and an active lifestyle with confidence.

To learn more, book a consultation with Mr Shah Punwar today.

Collagen supplements are increasingly lining pharmacy shelves and popping up in conversations about joint health. Patients often ask whether they might help with arthritis or tendon pain, and the short answer is that the evidence is promising, but not conclusive.

Understanding where collagen fits into the picture of arthritis management requires looking at both the science of how collagen works and the quality of the studies so far.

Collagen and joint structure

Collagen is the most abundant protein in the human body, forming the scaffolding of cartilage, ligaments, tendons, and bone. In arthritis, particularly osteoarthritis, collagen within joint cartilage breaks down faster than it can be replaced, leading to thinning cartilage, joint pain, and stiffness.

The rationale for supplementation is straightforward, providing the building blocks of collagen could help restore cartilage or slow its loss. But whether orally ingested collagen peptides can reach the joint and influence cartilage metabolism is more complicated.

Several small clinical studies have suggested potential benefits. One systematic review found that people with knee osteoarthritis taking collagen supplements experienced modest improvements in pain compared with the placebo.

Can collagen supplements help with arthritis?

Despite encouraging signals, the research is not yet definitive. Many of the available studies are industry-funded, small in scale, or lack long-term follow-up. The variability in supplement formulations, different types of collagen, dosages, and preparation methods, makes comparisons difficult.

It’s also worth noting that collagen supplements are not the same as collagen injections or biologic therapies being trialled in more advanced arthritis care. The supplements currently available are considered safe for most people, but their effectiveness is not guaranteed.

Where collagen may be most useful

For patients with early osteoarthritis or those experiencing tendon-related issues, collagen supplementation may provide symptom relief, particularly when combined with a structured exercise programme. Exercise appears to be key. Mechanical loading of the joint or tendon may help direct collagen peptides to where they are most needed, improving the repair response.

This fits with the broader principle that arthritis management works best when multimodal, combining lifestyle, exercise, and where appropriate, adjunct therapies like supplements.

Should you try collagen for arthritis?

For most patients, collagen supplements are safe and may be worth trying as part of a wider strategy to support joint health. They should not replace established treatments, such as physiotherapy, weight management, or, when necessary, surgical options, but may complement them.

Those considering supplements should keep expectations realistic. Benefits, if they occur, are usually modest, and not everyone responds in the same way. It’s also important to choose a reputable product, as quality control can vary widely in the supplement industry.

Collagen supplementation represents a growing area of interest in arthritis and tendon health. The science suggests potential benefits for pain and function, particularly when combined with exercise, but the evidence is not yet robust enough to make it a standard recommendation. Patients interested in trying collagen should view it as an adjunct rather than a cure.

If your symptoms cannot be relieved with medication or lifestyle adjustments, then joint replacement surgery may be the answer. If you’re struggling with knee or hip pain, schedule an appointment with Mr Shah Punwar for personalised treatment and management advice.

In the wake of an anterior cruciate ligament (ACL) tear, timing can be everything. Recent preclinical findings suggest that reconstructing the ACL sooner rather than later may reduce the risk of osteoarthritis.

A study presented at the American Academy of Orthopaedic Surgeons 2025 Annual Meeting, found that immediate ACL reconstruction leads to lower immune cell activity, fewer joint changes and less inflammation that could lead to knee arthritis later in life.

For anyone facing an ACL rupture, especially athletes eager to return to sport, understanding the benefits of early intervention is key to protecting the joints long-term.

The burden of knee osteoarthritis and why early ACL reconstruction matters

Osteoarthritis is the most common form of arthritis worldwide, affecting approximately 528 million people in 2019, an increase of 113 percent since 1990. The knee is the joint most frequently afflicted, with an estimated 365 million cases, leading to pain, stiffness, and reduced mobility.

After an ACL injury, persistent inflammation can accelerate cartilage breakdown, leading to osteoarthritis decades later. By reconstructing the torn ligament early, surgeons aim to quell the prolonged immune response in the knee that drives this degenerative process.

At the AAOS Annual Meeting, Hospital for Special Surgery investigators shared their preclinical study results. They found that immediate reconstruction may interrupt the cycle of inflammation before it leads to irreversible joint damage. Early reconstruction resulted in lower immune cell activity, less inflammation, and fewer cartilage changes associated with osteoarthritis compared to surgery delayed by one week or not performed at all.

Clinical evidence linking delay to cartilage damage

In a prospective observational study of 212 patients undergoing ACL reconstruction, severe cartilage damage rose from 3% in surgeries performed within six months of injury to 11.1% when delayed six to twelve months. It also skyrocketed to 63.6% after four years.

This survey, published in the Indian Journal of Orthopaedics Surgery, highlights how each month of ACL deficiency leaves the joint vulnerable to worsening chondral lesions.

Current guidelines from the American Academy of Orthopaedic Surgeons recommend reconstruction within five months of injury to protect articular cartilage and menisci. For patients experiencing recurrent instability or aiming to return to pivoting sports, early surgery doesn’t just heal the ligament; it safeguards the surface of the joint for years to come.

Early ACL reconstruction and returning to sport safely

For many patients, an ACL tear occurs during high-impact activities such as football, gymnastics or skiing. Early reconstruction not only curtails inflammatory damage but also allows rehabilitation to begin on a stable foundation.

Arthroscopic techniques, using autografts such as hamstring or patellar tendon, restore ligament continuity while minimising soft-tissue trauma. With a reconstructed ACL in place, structured physiotherapy can focus on regaining range of motion and strength. This approach typically sees athletes feeling ready to return to sport around six to nine months post-surgery.

Rehabilitation includes restoring full extension, achieving quadriceps strength symmetry, and passing functional tests such as single-leg hops. Delayed surgery often means more extensive cartilage damage and a longer, more cautious rehab process to protect the joint.

If you’ve suffered an ACL tear, don’t wait until chronic pain or swelling sets in. Early reconstruction offers the best chance to preserve your knee’s cartilage, reduce the risk of future osteoarthritis, and get you back to the activities you love.

Schedule an appointment with Mr Shah Punwar today.

Osteoarthritis of the knee is a leading cause of pain and disability, affecting millions of people worldwide. Excess body weight increases the mechanical load on the knee joint, accelerating cartilage breakdown and inflammation.

While diet and exercise remain the most effective form of weight management, a new class of weight loss medications, such as semaglutide, could also help.

Recent clinical research suggests that these medications may offer a substantial reduction in arthritic knee pain.

Here we’ll explore why weight loss matters when you have osteoarthritis, and whether weight loss medications are worth trying.

Why weight loss matters in knee osteoarthritis

Every extra kilogram of body weight places additional stress on the knee with each step, increasing the risk of cartilage injury and inflammation. Over time, this cumulative load contributes to the development and progression of osteoarthritis.

Studies have shown that even modest weight loss can translate into meaningful pain relief and improved function. For example, according to OARSI guidelines, shedding 5-10% of body weight can reduce knee pain by up to 20% and slow joint degeneration.

However, achieving and sustaining significant weight loss through lifestyle changes alone can be challenging. Many patients struggle with plateauing weight despite rigorous diet and exercise programs.

This is where weight loss medications can play a supportive role, helping patients overcome barriers and achieve the level of weight reduction needed to protect their joints.

The role of weight loss medications in reducing arthritic knee pain

GLP-1 receptor agonists such as Semiglutide, originally developed for type 2 diabetes, work by improving insulin secretion, slowing gastric emptying, and promoting satiety.

Semaglutide (marketed as Ozempic or Wegovy) is administered once weekly and has been shown to produce average weight reductions of 13.7% over 68 weeks in patients with obesity. In the recently published STEP 9 trial, 407 participants with a body-mass index (BMI) of 30 or higher and moderate-to-severe knee osteoarthritis were randomly assigned to receive either semaglutide 2.4 mg or placebo, alongside dietary and exercise counselling. By week 68, those on semaglutide lost an average of 13.7% of their body weight compared to 3.2% in the placebo group, and experienced a greater reduction in knee pain.

These findings suggest that semaglutide not only helps patients lose weight but also delivers clinically meaningful pain relief, likely driven by reduced joint loading and systemic inflammation.

Integrating weight loss medications into patient care

While the recent trial offers compelling evidence, GLP-1 receptor agonists are not a universal solution. Ideal candidates are patients with a BMI of 30 or above (or 27 with obesity-related comorbidities), who have struggled to achieve adequate weight loss through diet and exercise alone.

Before initiating therapy, it’s important to discuss potential benefits and risks, including gastrointestinal side effects and cost considerations.

Medication should complement, not replace, lifestyle interventions. A tailored physical therapy program remains essential to strengthen the muscles around the knee, improve flexibility, and correct gait mechanics. Also, maintaining a balanced, nutrient-rich diet, and staying hydrated, further support joint health and overall wellbeing.

Personalised treatment for knee pain

The current research shows that for those with knee osteoarthritis, new medications like semaglutide offer an additional avenue to relieve pain, improve function, and potentially slow disease progression. While long-term studies are still needed to confirm effects on joint structure, current evidence supports their use as part of a comprehensive treatment plan.

Patients should work closely with their orthopaedic surgeon to determine if weight loss medication is appropriate for them. If you’re struggling with knee pain, schedule an appointment with Mr Shah Punwar for personalised treatment and management advice.

Knee injuries can be unpredictable, and sometimes, you can develop more than one injury at the same time. While it isn’t overly common, it is possible to tear both your meniscus and anterior cruciate ligament (ACL) simultaneously. The forces that cause one injury often contribute to the other.

In the recent ski season, Mr Punwar has seen a few patients with injuries like this. If you are suffering with knee pain following any kind of trauma, it is important to get it checked out as soon as possible as there is a risk of it leading to further damage.

Here we’ll explore what happens when you experience a dual injury, and the treatment options available.

Injuring your ACL and meniscus together

The ACL is one of the key stabilisers in your knee, preventing excessive forward movement of the tibia. The meniscus acts as a cushion between your thigh and shin bones. When you experience a sudden twist or impact, whether while playing sports or from an unexpected fall, the same force that tears the ACL can also damage the meniscus.

In downhill skiing, despite many safety advances of ski boots, ACL injury remains one of the most common injuries. This is due to the forces of skiing on the ligaments of the knee. One study of alpine skiers found that nearly half of those with an ACL injury also sustained a concomitant meniscal tear.

When both structures are injured, symptoms often include a combination of instability, swelling, and pain. The overlapping signs can make it difficult to determine which structure is injured without a thorough clinical evaluation. It’s crucial to have the injury medically assessed at the earliest opportunity.

Advances in diagnostic imaging, like MRI, have significantly improved our ability to identify both injuries early on. This allows for an effective and coordinated treatment plan.

Repairing the ACL and meniscus

There are a few surgical options to repair these complex injuries simultaneously. During surgery, the torn ACL is usually reconstructed using a graft. This may be taken from your own tissue or, in some cases, from a donor, to restore stability to the knee. The procedure is done arthroscopically (keyhole surgery) where a small camera is inserted into the knee.

At the same time, the damaged meniscus is assessed carefully. Depending on the severity and location of the tear, your surgeon could choose to repair the meniscus or remove the damaged segment in a procedure known as a meniscectomy.

A key benefit of addressing both injuries at the same time is that it can streamline your recovery process. Performing both procedures concurrently means that the scar tissue/healing time is kept to a minimum and you only need to undergo one period of rehabilitation.

One review of outcomes of arthroscopic meniscal repair performed in combination with anterior cruciate ligament (ACL) repair found there were high rates of meniscal healing and it yielded favorable functional and clinical results. The success rate of the procedure was 89%, with an 11% re-tear rate in the meniscus.

Optimising your recovery

There are a few things you can do to optimise your recovery after a combined ACL and meniscus surgery. The initial couple of weeks post-surgery are the most difficult. During this time, managing pain and swelling, alongside plenty of rest is essential. Avoid putting undue pressure on your knee to allow your body to initiate the healing process naturally.

Using ice packs regularly, applying a compression bandage, or wearing a knee brace can help reduce inflammation and support your recovery.

As the healing progresses, gradually reintroducing movement is important. A structured physiotherapy program tailored to your needs will guide you through exercises designed to restore strength, flexibility, and stability. With both structures repairing simultaneously, this makes following a guided physio plan even more crucial to your recovery.

In addition to physical therapy, maintaining a balanced diet, staying hydrated, and getting enough sleep are all small but important parts of the healing process. While combined injuries are more complex than isolated ones, the coordinated care provided by your surgical team and physiotherapists plays a key role in recovery and a successful return to sports.

If you have concerns about a knee injury, book a consultation with Mr Punwar to discuss treatment options. Contact us by calling 020 8194 8541 or emailing info@shahpunwarortho.com.