August 1, 2011
This weekend, scientists from an American medical institution published a study that has practical implications for patients undergoing ACL (Anterior Cruciate Ligament) surgery.
The study, by a group in Utah, may have answered in part the long sought question of why some patients do well after knee surgery (quickly regain strength in their quadriceps) and some do not. Dr. Tyler Barker, of the Orthopedic Specialty Hospital in Murray, Utah, and his colleagues at the University of Utah (where I did a surgical internship back in 1976) discovered that vitamin D levels are associated with muscle strength recovery after knee surgery (anterior cruciate repair). Those with levels above 30 ng/ml recovered much better than those with levels below 30 ng/ml.
Tyler Barker, Thomas B. Martins, Harry R. Hill, Carl R. Kjeldsberg, Roy H. Trawick, Lindell K. Weaver, and Maret G. Traber Journal of Evidence-Based Complementary & Alternative Medicine. published 29 July 2011, 10.1177/2156587211413768
I found it somewhat disappointing that the authors refused to say that vitamin D deficiency should be treated before knee surgery. All they would say was that Americans should fund more studies before any action is taken. Of course this is neither practical or ethical, as physicians are (and always have been) obligated to act on what is known now -- not on what may or may not be discovered in the future. Randomized trials of vitamin D supplemention need to be undertaken to discover what the optimum vitamin D level for knee surgery is. But such trials will take years, while orthopedists need to act, or not, now.
-John J. Cannell, M.D