Knee Surgery: Reconstruction of the Anterior Cruciate Ligament
by: Dr. Stefan Tarlow on Tue, 2 Jun 2009 at: 1:20 PM Go to: Previous Article Next Article
ACL Reconstruction: An Overview
The ACL (anterior cruciate ligament) stabilizes the knee. It is easily torn because of its location and the extent of activity and stress the knee joint is subjected to on a regular basis. The choice to treat ACL damage with surgery is an individual choice.
The choice is based on factors such as the extent of damage to the rest of the knee structure, the knees stability, the activity level and age of the patient. If the patient will be able to return to the pre-injury activity level, surgery is usually recommended.
ACL reconstruction will stabilize the knee. This prevents further damage to the articular cartilage and the menisci (cartilage cushions). Surgery helps in preventing premature deterioration of the knee.
Without exception, ACL reconstruction is performed arthroscopically. I personally prefer to use an autograft-tissue graft. Autograft is a graft harvested from the patient. An allograft, which is harvested from a cadaver is another possibility.
I think that using the patients own tissue results in a more successful reconstruction that yields better long term results. Specifically, I believe that by using the patients own tissue, ACL re-injury rates are lowered. Interestingly, there have been two scientific studies conducted in the past few years that indicate a high failure rate - ten to twenty-five percent - if a young patient (under 25) receives allograft tissue and also participates in an aggressive program of rehabilitation.
Click here to learn more about knee arthroscopy.
I prefer to use a Patellar Tendon Autograft and an interference screw fixation when I have a patient under thirty years old who does not have any underlying patellofemoral disease. In addition, I prefer Hamstring Autograft (semitendinosis and gracilis combined) using rigid extra-articular fixation (Rapid Loc or Toggle Loc) on the femur and a Washer Loc on the tibia.
If my patient is under the age of 25, I am willing to use an allograft only if the patient will avoid aggressive and competitive sports for a complete year. This will allow the allograft enough time for healing. Additionally, I am willing to use allografts if I am reconstructing more than one ligament.
The knee is stabilized and stress is kept at a minimum across the knee joint by the ACL.
The ACL prevents an excess of forward movement of the tibia (lower bone of the leg) in relation to the femur (thigh bone).
Additionally, it prevents excessive rotational movement of the knee.
Click here to learn more about Dr. Stefan Tarlow, a leading Phoenix Knee Doctor.
About the Author
Dr. Tarlow is a Board Certified Orthopaedic Surgeon with over 20 years specializing in knee surgery. He opened his own clinic, Advanced Knee Care, with a focus on specialty patient care. Click here to learn more about Dr. Tarlow, Phoenix knee surgeons and Phoenix-area Knee Arthroscopy.
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