An Overview of ACL Reconstruction

The ACL (anterior cruciate ligament) stabilizes the knee. It is easily torn because of its location and the extent of activity and stress the knee joint is subjected to on a regular basis. The choice to treat ACL damage with surgery is an individual choice.

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.

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My preference is to use a Patellar Tendon Autograft combined with interference screw fixation when dealing with patients under thirty years of age who do not have any underlying patellofemoral disease. I also prefer Hamstring Autograft (semitendinosis and gracilis combined) using rigid extra-articular fixation (Rapid Loc or Toggle Loc) on the femur along with a Washer Loc on the tibia.

If the patient is under age 25, I have been known to use an allograft as long as the patient guarantees he will not engage in aggressive, competitive sports for a full year following the surgery. This period of time gives the allograft a chance to heal. Also, I will use allografts when there is more than one ligament that needs to be reconstructed.

The ACL acts to provide stability for the knee and to keep stress at a minimum across the knee joint:

The ACL prevents an excess of forward movement of the tibia (lower bone of the leg) in relation to the femur (thigh bone).

Additionally, it prevents excessive rotational movement of the knee.

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