Anterior Cruciate Ligament (ACL) Reconstruction
ACL reconstruction surgery is the gold standard treatment for a significant ACL injury. The procedure involves the removal of the torn ligament and replacing it with a graft.
ACL reconstruction surgery is recommended for younger and active patients who have experienced an ACL tear. The goal of surgery is to reconstruct the ACL to recreate the complex anatomy and biomechanics of the natural ligament and return the patient back to their active lifestyles with the lowest rate of reinjury.
Reconstructing the ACL – deficient knee may also reduce the risk of long-term complications due to instability, such as injury to the menisci and cartilage. Additionally, reconstruction has been shown to be economically advantageous with an increase in quality-of-life compared to rehabilitation and non-operative management.
Many graft options exist for anterior cruciate ligament reconstruction. Graft options include autografts taken from the patient, allografts from a donor, and hybrid grafts. Graft choice is crucial. Autografts are the preferred graft choice for younger patients and patients who lead an active lifestyle. Optimal graft type is one of the most important decisions in ACL reconstruction.
Choosing the right graft
Each graft has unique features, advantages, and disadvantages. Ultimately the graft choice is individualized based on multiple factors including:
- Evidence from high quality research studies
- Patel’s experience
- the patient’s age
- the patient’s sports activity level
- the mechanical demands on the reconstructed knee
- the associated graft failure rates
- donor site damage
- the patient’s prior surgery, extent of the injury and their goals and preferences.
Each patient will have unique injury characteristics and expectations. Therefore, the goal is always to determine the optimal graft for the individual.
With proper care and planning, complications as a result of ACL reconstruction surgery are rare but not totally uncommon. These complications can include:
- Allergic reactions to medications
- Infections (approximately 1 in 200 patients)
- Deep vein thrombosis, or clotting
- Swelling and bruising
- Graft failure
- Nerve damage
- Continued pain
Dr. Ronak Patel takes precautions against all these risks, and this lowers the complication rate. Dr. Patel uses pre-operative antibiotics, compression stockings and blood thinners when necessary, meticulous surgical technique to enhance graft fixation, and accelerated rehabilitation.
Several studies suggest it is optimal to wait 3 weeks from ACL injury to prevent the risk of knee stiffness after surgery. This is flexible and revolves around obtaining full extension and flexion in the knee prior to surgery.
Two exceptions are 1) the elite athlete in which time to return to play is critical and 2) if there is a displaced meniscus tear that will not allow a full range of motion.
Studies also suggest that it is best to perform ACL reconstruction within one year of injury. A higher rate of meniscus and cartilage injury is seen inactive individuals who have an unstable knee and continue to perform high level activities. This can potentially contribute to early arthritis.
Dr. Ronak M. Patel is a double board-certified orthopaedic surgeon and sports medicine physician trained at Northwestern University and received a fellowship at the Cleveland Clinic. He specializes in the treatment of all knee injuries and degenerative conditions. When you or a loved one suffers an ACL injury, contact Dr. Ronak M. Patel to schedule a consultation where you will learn about all your treatment options. He specializes in the treatment of sports injuries and ACL surgery for teens and adults in Chicagoland and NW Indiana.
At a Glance
Ronak M. Patel M.D.
- Double Board-Certified, Fellowship-Trained Orthopaedic Surgeon
- Past Team Physician to the Cavaliers (NBA), Browns (NFL) and Guardians (MLB)
- Published over 49 publications and 10 book chapters
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