An Overview on Anterior Cruciate Liagment Reconstruction (ACL Reconstruction)
The anterior cruciate ligament (ACL) is located in the front (anterior) of the knee and crosses (cruciate) in front of the posterior cruciate ligament (PCL). The ACL is responsible for providing knee stability during rotational movements or twisting actions. The ACL is the most commonly injured ligament in the knee joint in the athletic population. An ACL tear can occur from a sudden stop or change in direction, typically found in soccer, basketball, tennis, football and gymnastics. An ACL repair, typically an ACL reconstruction, is required in the majority of patients to return knee stability and function. Dr. Mark Getelman, knee surgeon, specializes in ACL surgery in patients living in the Van Nuys, Thousand Oaks and Los Angeles, California communities.
Many patients who experience an ACL injury hear a “pop” and then experience knee pain, swelling and instability. The ACL does not heal on its own due to the ligament’s environment. An ACL reconstruction is usually recommended by Dr. Getelman to restore patient’s knee function and mobility. In older, less active patients, a physical therapy and rehabilitation program may be recommended instead of an ACL repair.
A surgical ACL repair is known as an ACL reconstruction and involves a new graft being placed along the course of the torn ACL. Dr. Getelman will begin ACL surgery by examining the knee joint to fully evaluate the extent of ligament damage. He will also view the other ligaments and surrounding structures to determine if additional damage is present. If other knee injuries are present, Dr. Getelman will typically plan to repair all injuries during the same ACL surgery.
Using an arthroscope and special instruments, Dr. Getelman will remove the damaged ligament and create bone tunnels for the new ACL. The ligament is then reconstructed using a graft similar in size to the native ACL. ACL reconstruction grafts include:
- Allograft: donor tissue is harvested from several sources including tibialis anterior or posterior, the Achilles tendon, or the patella, quadriceps tendon and used to reconstruct the damaged ACL.
- Autograft: The patient’s own tissue is harvested from his/her patellar tendon, hamstring or quadriceps tendon and is used to reconstruct the torn ACL.
It is important to note the ACL must be reconstructed rather than repaired due to its limited healing ability. It is also important the replacement graft is placed in the exact anatomic position of the original ACL to allow for proper healing and knee function. This is best approached through an accessory anteromedial portal which Dr. Getelman has championed and uses routinely. Dr. Getelman will discuss each patient’s injury and graft options, as well as the benefits and risks of each surgical option prior to ACL surgery.