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An Overview of ACL Reconstruction

The ACL (anterior cruciate ligament) is the stabilizer of the knee. It is torn easily because of the extent of activity and stress the knee joint is subjected to on a regular basis and the location of the ligament. Each patient must make the choice as to whether or not his or her ACL damage should be treated surgically.

The choice is based on factors such as the extent of damage to the rest of the knee structure, the knees stability, the activity level and age of the patient. If the patient will be able to return to the pre-injury activity level, surgery is usually recommended.

ACL reconstruction will stabilize the knee. This prevents further damage to the articular cartilage and the menisci (cartilage cushions). Surgery helps in preventing premature deterioration of the knee.

Across the board, ACL reconstruction surgery is performed arthroscopically. Personally, I believe that an autograft-tissue graft that comes from the patient is the best thing to use. The alternative is an allograft. This is a graft harvested from a cadaver.

However, I believe these are subject to problems in the long term. Indeed, recent research has shown that patients under the age of 24 who receive an allograft and then participate in an aggressive rehabilitation program are 10-25% more likely to have a high failure rate.

Click here to learn more about knee arthroscopy.

I prefer to use Patellar Tendon Autograft with interference screw fixation for patients below the age of 30 who have no underlying patellofemoral disease. Additionally, I prefer Hamstring Autograft (semitendinosis and gracilis combined) with a rigid extra-articular fixation - the Rapid Loc or Toggle Loc, for example - on the femur as well as the Washer Loc on the tibia.

If my patient is under the age of 25, I am willing to use an allograft only if the patient will avoid aggressive and competitive sports for a complete year. This will allow the allograft enough time for healing. Additionally, I am willing to use allografts if I am reconstructing more than one ligament.

The ACL keeps the knee stabilized and stress at a minimum across the knee joint.

Excessive forward movement of the tibia (lower bone of the leg) in relation to the femur (thigh bone) is also prevented by the ACL.

Additionally, it prevents excessive rotational movement of the knee.

Click here to learn more about Dr. Stefan Tarlow, a leading Phoenix Knee Doctor.

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