What is the ACL? 

 The ACL is one of four major ligaments inside the knee that is responsible for maintaining stability of the knee during certain activities. 

How do ACL injuries occur? 

Most ACL injuries are non-contact in nature.  Usually the athlete or decelerating rapidly, turning, pivoting or twisting.  The knee will buckle or give out and frequently a pop is felt or heard.  The knee will usually swell significantly within the first hour or two.  

 What is the immediate treatment for ACL injuries?  

 If you suspect you have suffered an ACL tear you should immediately put ice on your knee, apply compression via an ACE wrap (not too tight) and obtain a pair of crutches... you may need to see your orthopedist or visit an Emergency Room for these. 

You should have the knee examined and have X-rays taken within the first few days.  Usually a physical examination will confirm the presence of an ACL tear.  A good Sports Doc will be able to tell by examining you if the ACL is torn.  An MRI can help confirm the presence of a tear and it will also show if your tore your meniscus cartilage as well.  

Is surgery necessary to reconstruct the ACL...Is it an emergency? 

 Surgery to reconstruct the ACL is not emergency surgery and should be postponed until the swelling has diminished and you have restored range of motion to the knee.  The stronger and more flexible your knee is going into surgery, the better you will recover from the surgery. 

Surgery is necessary for most young athletes.   An ACL is necessary to compete in any sports with cutting pivoting or twisting.  Unless you want to change your lifestyle, a reconstruction is the preferred method of managing complete tears.  Bracing is an option for a small subset of patients who do not have instability with normal activities and skies easy trails once or twice a year.  Bracing is not a good option for any competitive athlete with instability symptoms following an ACL tear.  

What does the surgery entail?  

 Surgery involves the reconstruction of the native ligament.  The ACL can not be repaired in a traditional sense.  During surgery we drill tunnels which enter and leave the knee joint where the ligament used to be. We then pass a "graft" through the tunnels and lock the graft in place under tension. 

Which graft should I choose?   

 The choices for which tissue to use as a graft comes down to two basic choices, allograft or autograft.  An allograft is taken from a cadaver and autograft is your own tissue.  If choosing your own tissue we have the hamstring tendons or the patella tendon as a choice for grafts and with allografts we have a multitude of choices available.  Autograft is typically favored over allograft.  Allografts carry risk or disease transmission... and to minimize that risk, many companies will irradiate grafts which could weaken them in the long run.  For a primary ACL reconstruction autograft is probably your best choice.  

 What is a Double Bundle Reconstruction?

 A normal "native" ACL has two bundles that it is composed of.  An anteromedial and a posterolateral bundle.  99.9% of reconstructions performed today only recreate the AM bundle.   Freddie Fu, 5 or so years ago proposed that we should be reconstructing both bundles to better control rotational instability that some patients continue to complain of after a routine ACL reconstruction.  

A double bundle recon involves four tunnels and two separate grafts...usually hamstring grafts to recreate both AM and the PL bundles.  

I have been very happy with the results of my DB-ACL reconstructions, as have others, but is it going to take a head to head large multi-center study to determine which one is actually better.    That way we can provide an answer that is evidence based and supported by the literature.