Our approach to ACL Surgery has changed dramatically over the last few years. We’ve changed how we perform ACL surgery, how we rehabilitate your knee after ACL surgery, and we’ve learned a lot about the science of trying to prevent ACL tears.
The ACL is the anterior cruciate ligament. It is one of four major ligaments within our knee. The ACL is clearly the most commonly injured of the 4 major ligaments. Most people who tear their ACL have sustained a twisting or pivoting injury. The most common sports leading to an ACL tear include soccer, football, basketball and skiing.
If you have an ACL tear, you will likely find that you have instability or giving way with certain sports and activities. If you have an ACL deficient knee and you have instability then you are likely considering an ACL reconstruction. For those of you considering ACL surgery, but you’re not quite sure if you need it, you will find this post helpful.
4 Tips to Prepare You For ACL Surgery:
- The technique for performing an ACL reconstruction has evolved significantly. Over the last few years nearly all high volume ACL surgeons have gone to an “anatomic” approach. That means that during ACL surgery we put the new ligament in exactly the same position your native ligament was. Believe it or not, that’s not how we were originally trained how to do it. The older technique was easier… which is likely the reason why some surgeons still use it. Take Home Message: An “anatomic” reconstruction has become the gold standard. It is a more technically challenging procedure, so be sure to review with your surgeon what technique they plan on using.
- Volume matters ! An ACL surgery is a technically challenging procedure. ACL surgery should be performed by those of us who are experienced ACL surgeons. The complication rate of a low volume ACL surgeon is significantly higher than an experienced ACL surgeon. Take Home Message: Be sure to find an ACL surgeon that performs a fair number of ACL reconstructions each month… not a few each year.
- When we reconstruct the ACL we need to create a new ligament. We can chose to use your hamstring tendons, a piece from your patella, or a donor graft from cadaver tissue. Different grafts are better suited for different situations. Women tend to be “quadriceps dominant” so a patella graft might better suit their needs. A patella tendon graft might be better suited for high level contact athletes. A hamstring graft is a strong graft well suited for most all activities. The research shows that a cadaver graft in a young active person should probably be avoided due to a high failure rate. Take Home Message: One graft does not suit all needs for people considering ACL surgery. Be sure to do your research and talk to your surgeon about your goals so the proper ACL graft can be chosen.
- If you have suffered an ACL tear, you are at very high risk for re-tearing the ACL in the same knee — or tearing the ACL in the other knee. Many people have a predisposition due to a “neuromuscular” impairment. (I hate big words too) That basically means the way you jump, land, pivot, etc needs to be evaluated to correct your biomechanics to dimish your risk of requiring another ACL surgery. Take Home Message: Physical therapy is an absolutely critical part of the overall ACL recovery process. Finishing up with a formal neuromuscular evaluation may play a role in diminishing your risk of a second ACL tear.
I hope these tips help with some of the larger issues at hand when considering ACL surgery.
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