Knee Surgery: Reconstruction of the Anterior Cruciate Ligament

An Overview of ACL (anterior cruciate ligament) 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.

Surgery is chosen with such factors as the patients level of activity, age, and the stability of the knee in mind. Additionally, it is necessary to know if other knee structures have experienced damage. Surgery will normally be recommended when it will let the patient return to the previous level of activity.

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 think allografts are subject to problems. Recent research has indicated that patients under age 25 who receive an allograft followed by an aggressive rehabilitation program are 10-25% more likely to have problems.

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 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).

Excessive rotational motion of the knee is also kept under control by the ACL.

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

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