Surgical Reconstruction of the ACL
In order to restore stability to the knee and to limit the premature joint damage and arthritic knee from developing, surgical reconstruction of the ACL is advised in the young and middle-aged individual. Rather than attempting to repair the shredded ACL itself, the ligament is reconstructed using a graft. Grafts can come from one of three sources: a patellar tendon graft, a hamstring graft or an allograft (cadaver). The type of graft utilized is influenced by a variety of factors, including your age and the sport or type of activities you enjoy. Your physician will discuss the advantages and disadvantages of each type of graft with you.
Acutely torn ACL: Surgery to reconstruct the ACL is ideally performed within the first 3 to 21 days after the injury. It may be beyond this length of time until joint range of motion is near normal, thigh muscle function is returning to normal, the resolution of swelling has occurred and when the surgical date is appropriate for your school, work and home schedule.
Chronic ACL tears: The same method of reconstruction is utilized. Additional ligament reconstructions or rebuilding of stretched out ligament may be necessary, as well as cartilage surgery of either the meniscus or articular cartilage.
Emotional support of the young athlete:
Telling your child the news that their ACL is torn can be quite emotional for both the child and parents. Most young athletes are only able to see the present and are not particularly interested in hearing about preventing arthritis in the future. They “hear” very little of the benefits of the surgery but will tend to focus on being taken away from their sport and the insecurity of having their position affected. For you, the parent, you have the challenge of supporting your child while also dealing with your own disappointment over their injury. It is important to remind your child that a significant number of high level athletes they see competing today have been through an ACL reconstruction in their past and have successfully returned to their sport. Second, in the majority of cases, there is not something the athlete could have done to have prevented the injury. The reality is that the more your athlete participates in a sport at a high level, the greater their exposure or vulnerability to injury. Third, keep your athlete focused on looking forward to the opportunities that will still be open to them in the future!
Benefits of ACL Reconstruction - Restore joint stability:
Rebuilding the ACL with a graft is highly reliable, with a greater than 95% chance of success of restoring normal stability to the knee. Studies have shown that greater than 90% of individuals are able to return to all forms of athletic and work activities. This includes sports such as football, soccer, basketball, and skiing as well as manual labor. Professional athletes with this type of surgery return to their previous level of competition in the great majority of cases.
Reduced potential for joint damage: Reconstruction of the ACL combined with appropriate meniscus repair surgery stabilizes the joint and helps prevent any additional meniscus or articular cartilage damage from occurring. This will help minimize the development of arthritic changes previously discussed. If meniscus or cartilage damage is already present, stabilization of the joint will not reverse this damage but will slow down the progression of joint damage and wear.
Scheduling your surgery: Your physician will make the decision when your knee is appropriate for surgery. Most ACL surgeries are done as an outpatient at a surgery center and you should anticipate going home the same day, barring any problems. Depending upon circumstances, your physician may feel that you should have your surgery as an overnight stay in the main hospital. Either way, following your physician's instructions will be important to your speedy recovery.
