Torn ACL: Repair & Reconstruction (ACL Surgery)
The anterior cruciate ligament, or ACL, is like a rope. The ACL goes from the femur to the tibia to stabilize the knee. We initially thought the ACL provided front-to-back stabilization, but we have learned through recent biomechanical studies that it controls knee rotation. It’s role is most important in decelerating activities.
Seventy percent of all ACL injuries are non-contact injuries. It occurs when an athlete lands from a jump or changes direction, and the force on the ligament ruptures it. They then have a knee that is unsable, especially with sports that require side-to-side movements.
The ACL is unique in that it is in a hostile environment in the knee. You can’t sew a Torn ACL together because it simply won’t heal. Current standard of practice is to replace the anterior cruciate ligament with either a tendon from somewhere else in the body, or tissue from the tissue bank, which is very similar to receiving blood. Allograft is the term for when we use a tendon from the tissue bank to replace a torn ACL.
A good candidate for an ACL reconstruction would be a younger patient who’s very physically active, involved i decelerating sports and is not overweight or has other medical comorbidities. At the other end of the spectrum, if a 65 year-old has a torn ACL, other health issues, and no involvement in deceleratingports, they would be a very poor choice to have ACL surgery. You can do an ACL reconstruction at any age. However, if someone is having painful instability, you can always do anACL reconstruction. Most people in their 50’s and 60’s can make activity modification and not have sufficient problems to warrent knee surgery that is complex and requires six months of rehabilitation.
We generally define success as returning to the same level of play as before the ACL injury. So whether it’s at the high school or college level, success is returning to the same level of play. It does not proclude progressing to the next level. ACL surgeryhas become so common in the United States, and the techniques have become so refined, that properly diagnosed and treated ACL tears are not an impairment to an athletic career.