What is ACL reconstruction?
Anterior cruciate ligament (ACL) reconstruction is a surgical procedure that replaces a torn ACL with a tendon graft in order to address painful instability of the knee. The surgery is carried out arthroscopically through small incisions.
How is an ACL reconstruction performed?
An ACL reconstruction is performed through minimally invasive knee arthroscopy. Once the torn ACL has been debrided from the central aspect of the knee, bone tunnels are drilled into the femur and tibia to allow passage of a tendon graft, which will become incorporated as the new ACL. The tendon graft is secured to the bone tunnels using biocomposite absorbable screws and a small titanium button with suture material.
Where is the tendon graft obtained for ACL reconstruction?
There are two broad categories of tendon grafts available for ACL reconstruction: autograft and allograft. Autograft refers to tendon graft obtained from the patient (usually a portion of the hamstrings or patellar tendon) while allograft refers to tissue obtained from a tissue bank. Since autograft is your own tissue, it does not need to be processed for sterilization prior to implantation. In contrast, allograft tissue must be processed to reduce the risk of disease transmission. There are pros and cons to each and both autograft and allograft have been used with great success in all types of patients including elite athletes. The pros of autograft include complete biocompatibility of the tissue with no need for sterilization, which may potentially weaken the collagen fibers in the graft. The pros of allograft include shorter surgical time and no donor site morbidity.
Dr. Garabekyan recommends using hamstring autograft for patients who are younger than 25 years of age due to its superior ability to maintain its implanted length, given that some studies have shown a gradual stretching/loosening of allografts in this patient population. For patients between 25 and 40 years of age, it is dealer’s choice and the patient may choose the option that suits their preferences based on the list of pros/cons above. Patients above the age of 40 years are recommended to undergo allograft reconstruction to minimize donor site morbidity.
What is the typical timeframe for recovery from ACL reconstruction?
It is important to realize that the speed of recovery depends largely on the extent and type of damage along with other patient related factors. Generally speaking, though, the majority of patients can expect to:
- Go home the day of surgery
- Resume normal daily household activities within 1 – 2 days
- Take prescription pain medication for 1 – 2 weeks
- Return to a desk-job with intermittent walking at 3 – 4 weeks
- Drive a car at 7 – 10 days
- Walk unassisted and without a limp by 4 – 6 months
- Start running at 10 – 12 weeks
- Return to unrestricted sports participation or a labor-intensive occupation at 4 – 6 months
How successful is ACL reconstruction?
The vast majority of scientific studies have produced good to excellent outcomes in 85 – 95% of appropriately selected patients undergoing ACL reconstruction; with some studies reporting lasting benefits for up to 10 years post-operatively. However, the reproducibility of these results is dependent on many factors.
Am I a good candidate for ACL reconstruction?
Whether ACL reconstruction is a worthwhile option for you depends on a number of factors, including:
- Your age
- Your particular diagnosis or pattern of injury
- The extent of arthritis or cartilage damage
In general, the outcomes of ACL reconstruction are best in patients < 40 years of age with minimal arthritis. Dr. Garabekyan will guide you through the various considerations in helping you decide whether ACL reconstruction is right for you.
Choosing the treatment option that is right for you involves careful consideration of your diagnosis, duration and severity of symptoms, desired level of activity, as well as social and financial elements. You are not alone in this process.
As you research your condition, please write down all of your questions and bring them with you to your next appointment. Dr. Garabekyan and his team will take time to address all of your concerns, until you are completely satisfied with your treatment plan.
We look forward to helping you get your life back.