ACL Injuries are now common place. The prospect of ACL surgery requires planning and preparation. The more you know, the better prepared you are to choose the right ACL surgeon, the proper cruciate ligament graft and the proper approach for the entire process.
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 cruciate ligament 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 an experienced ACL surgeon. 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 choose 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.
Volume matters! An ACL surgery is a technically challenging procedure. ACL surgery should be performed by an experienced ACL surgeon. The I hope these tips help with some of the larger issues at hand when considering ACL surgery.
Your second tip is a big one for me. A surgeon should know exactly what they’re doing. Just because they’ve done some type of orthopedic surgery in their past, it doesn’t mean they’re the most qualified now. It’s always a good idea to ask them about their experience and the injuries they commonly treat.
Thank you Jenn.
Dr. Luks,
Any thoughts about a 15 year old female, congenitally mission the ACL? Orthopedic consultation yielded a reccomentation by the surgeon to pursue PT and lost 10-15 lbs (patient is and will remain 4″10″). The problem is she has impaired impulse control, (FASD) IQ and learning delays. Food and TV are simple and accessible comforts for her, though we try to divert that. My hopes for the future are realistic and I doubt greens will supersede them.
I have personally witnessed 2 falling down stairs accidents (head over heels) and we’ll be lucky to arrive at 18 without a broken bone (or neck!) We have monthly sprains, strains, knee popping out, pain, swelling, Ibuprofen and limited mobility frequently She did do drill team, but as always, the night before final performance, the knee collapsed.
Do we live with this as is? Do we seek a virgin ACL construction (not re-construction) aside from the first surgeon’s opinion? Do we just hope PT and 10-15 lbs weight loss (unlikely) does the trick? What should we do? I would assume that years of this will yield arthritis, etc and things getting worse. Any comments you can offer, generally?
Thank you!
Hi MB … This is a very rare condition. The treatment, if your daughter’s knee remains unstable might need to be an ACL (re)-constuction. These can be challenging because the anatomy of the area where the ACL should be is usually not normal. So the surgeon will need to do some work in there to prepare the knee for a new ligament. Here is a case report … http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341811/
Good Luck !
Dr. Luks I’m just finding your site and I see some really good information and would like some feedback about my situation. I injured my left knee on March 4th,2015 and the MRI is showing a complete ACL tear and avulsive fracture. This is my first knee injury and I am very concerned about what method to take for recovery. I am a 36 yr old moderately active wife and mother of two toddlers. Allograft is what is being suggested. I am considering autograft as I don’t like the idea of a foreign object and feel that my own tissue will do better. However, was warned about pain and additional heal time. I also am concerned as I don’t have full flexibility of my knee. Based on information I have read I also feel like I need physical therapy to avoid permanent difficulties and recovery after the surgery. Please help me!!! Anyone please feel free to give me your thoughts.
Hi ..
You are correct … having pre-habilitation to improve your ROM and strength is critical! IT also allows you to meet with your PT team and see if they are a good fit! No doubt that autograft has advantages … it does heal faster. The difference between an allograft and hamstring autograft from a pain perspective is not very different at all. A patella tendon graft will hurt more for the first week.
Good Luck on your decision making!
Howard Luks
Dear Doctor, I am 48 years old, while playing tennis my knee got twisted and my left knee ACL is torn completely. Until now there is no instability or buckling. I can walk, jog, climb stairs, can stretch and flex my knee almost completely with minimal discomfort. I am willing to give up tennis and do thread mil as well as swim. I am willing to use a brace while climbing stairs and jogging. Is ACL reconstruction surgery a must for my age and conditions.
Thank you.
Regards,
Farooq
It is not a must… We perform ACL surgery on people with instability.
Very informative article and comments. Do you have any views on the various screw types used for ACL surgery? How much sense does it make to use the biodegradable type or not? It seems the surgery is costlier with those.
Bio screws have been disappointing. They tend to be weaker and can leave a hole in the bone during reabsorption.