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Your Good Health: Not every ACL tear will call for a surgical procedure

Surgery always has risks. Infection and blood clots are among the most common
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Dr. Keith Roach

Dear Dr. Roach: I am a 74-year-old male. I have exercised at the gym for over 35 years. I take 10 mg of a simvastatin once a day for high cholesterol. I also take metoprolol (50 mg in the morning and 25 mg at night) for high blood pressure and my irregular heartbeat.

Recently, I have been experiencing some stinging in my left knee when I crouch down. After an MRI, my orthopedist informed me that my anterior cruciate ligament (ACL) was completely torn. I was shocked. When he told me that he would not do surgery unless my knee was buckling (which it is not), I was so shocked that I didn’t ask him the obvious question of why. Can you provide more information on why surgery would not be recommended in this situation?

T.M.

Not every person who suffers a tear of the ACL requires surgery. As your surgeon said, an unstable knee is one reason to do the surgery, and a sense of the knee giving out while going upstairs is a common symptom. However, some surgeons will recommend surgery to patients who exercise (professionally or recreationally) in a way that causes high stress to the knee, such as jumping, pivoting and quick accelerations.

Surgery always has risks. Infection and blood clots are among the most common risks, but failure of the ACL graft, post-surgical arthritis and scarring are also possible. Your irregular heart rate and cholesterol issues aren’t reasons to avoid surgery, though.

I preferentially refer my patients to surgeons who are reluctant to operate unless there are clear indications. Sometimes a person who is recommended to defer surgery will develop problems later on; if that happens, the decision about surgery can then be reconsidered.

Dear Dr. Roach: One of my friends has a “leaky gut” and, consequently, an extremely limited diet. She claims that each time a food item does not agree with her, she needs to use the bathroom within 15 minutes of consuming of that item. Can a food item move through the entire digestive tract within 15 minutes?

K.S.

No, under normal conditions, the time it takes for food to traverse the entire gut is between 10 and 73 hours. It can be somewhat faster under extreme conditions such as a major bleed in the stomach. But what your friend is noticing may not mean that the food went through her so quickly; instead, it’s a condition called a gastrocolic reflex.

This is a physiological response to food in the stomach and causes the colon to become more active. This reflex is particularly strong in people with irritable bowel syndrome. The term “leaky gut” is often used by laypeople, but there is no strong evidence that the gut is particularly leaky in people who notice these symptoms.

Fatty food, large meals and other foods can stimulate a particularly strong gastrocolic reflex, which can cause cramping, loose bowel movements and even pain. There are many types of treatment, and I worry about people with such a limited diet, as that can sometimes lead to a lack of nutrients.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu