An Overview of ACL (anterior cruciate ligament) Reconstruction

The knee is stabilized by the ACL. It is often torn because of the location of the ligament and the fact that external forces are often exerted on it by activities causing damage. Each individual makes the choice of how to treat damage to the ACL.

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.

Surgery acts as a stabilizer to the knee. It also helps prevent secondary damage to the menisci (cartilage cushions) as well as the articular cartilage of the knee. The hope is that surgery will help prevent premature knee deterioration.

Without exception, ACL reconstruction is performed arthroscopically. I personally prefer to use an autograft-tissue graft. Autograft is a graft harvested from the patient. An allograft, which is harvested from a cadaver is another possibility.

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 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.

In addition, excessive forward movement of the lower bone of the leg (tibia) in relation to the thigh bone (femur) is prevented by the ACL.

Excessive knee rotation is also kept under control by the ACL.

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