The anterior cruciate ligament (ACL) runs diagonally through the middle of the knee joint, and is primarily responsible for rotational stability. A strained or partially torn ACL often heals on its own, but a complete tear requires surgery to reconstruct the ligament.
Repair vs Reconstruction
A torn ACL requires a reconstruction rather than a repair. Simply suturing the two torn pieces together generally does not fully heal, often tearing again, and therefore the ACL is reconstructed using a ligament graft.
Allograft vs Autograft
ACL grafts can be made using donor tissue (allograft) or using the patient’s own tissue (autograft). Athletes and younger patients often prefer to use an autograft, made from their own tissues, as they are generally stronger and hold up better for athletes. Autografts are usually harvested from the hamstring tendon or the patella tendon at the beginning of the reconstruction surgery through an additional incision.
Older patients may choose to use an allograft, donor (cadaver) tissue, as the surgery provides a faster recovery and return to work, which is beneficial for those not returning to vigorous sports.
ACL reconstructions are performed arthroscopically as outpatient (same-day) surgery at Texas Surgical Center. The surgery is often scheduled several weeks after the injury when the swelling and inflammation has reduced.
The procedure can be performed using arthroscopic techniques, which involve creating a few small incisions in the knee, into which a camera and tiny surgical instruments are inserted. The torn ACL is removed, and the new ligament is grafted into the femur and tibia. Arthroscopy offers patients a less invasive procedure with less scarring, less pain, less bleeding and a shorter recovery time.
Recovery and Physical Therapy
Following ACL repair surgery, patients can return home after a few hours of medical observation. Patients may use a post-op brace and crutches to protect the leg for a few weeks, but will begin movement of the knee right away. Some patients may use a CPM (continuous passive motion) machine to ensure the knee maintains good motion and flexibility without putting any strain on the new ligament.
Physical therapy will continue for several months to regain strength and stability. Most athletes will be allowed to return to sports after 6 months, and may be given a functional knee brace that provides extra support for the ACL.