An orthopedic knee specialist sets the record straight on ACL surgery and a special technique that helps a return to natural knee movement.
Dear Doctor: I injured my anterior cruciate ligament (ACL) and I’ve been putting off surgery. I’m concerned about the time it takes to rehab afterwards, and that my knee won’t feel right or move “normally” anymore.
Before I answer, here’s a quick anatomy lesson. The knee consists of four bones of the thigh and shin that are held together by four primary ligaments, which also help to stabilize your knee.
The ACL is one of the most important of those ligaments. It actually consists of two parts – the slightly larger anteromedial bundle, positioned in front of the posterolateral bundle. It’s easy to injury the ACL especially if you play sports such as soccer or basketball, where you are constantly stopping and starting and changing directions.
Unfortunately, half of all injuries to the ACL are accompanied by damage to other structures, including other ligaments, cartilage and the meniscus, which is the C-shaped cartilage on the top of the tibia bone. When the ACL is strained or torn, the meniscus has to work extra hard to stabilize the knee. One study found that delaying an ACL tear reconstruction beyond six months post injury can lead to tears of the meniscus – something you would definitely want to avoid!
So, the sooner you deal with your ACL sprain or tear, the better.
The good news is there are great surgical options for ACL repair, with minimal pain and downtime. Most ACL reconstruction surgeries offered today are done using a single-bundle reconstruction. A single-bundle ACL reconstruction uses one graft from an existing tendon or part of a cadaver to replace the torn anteromedial bundle (the longer ligament bundle), since tears can’t be sewn or repaired.
Cutting Edge Surgery for Knees
When possible, I prefer to perform a double-bundle ACL reconstruction, when both bundles are individually replaced. Although it is more technically demanding, a double bundle ACL reconstruction restores the knee structure, function and motion better and provides more rotational stability than a single bundle ACL reconstruction.
Typically, after an ACL surgery, I have my patients up and moving (with crutches and minimal pain) in a matter of days. Following a regimen of physical therapy, patients are usually walking unassisted in about a week, and, after a regimen of guided physical therapy, are ultimately able to return to the sports and activities they love.
If you think you may have an ACL injury, the first step should be getting evaluated by an orthopedic surgeon who can assess your specific injury and recommend the best treatment and surgery for you. Your knee is one of the strongest and most important joints in the body. Take care of your knee and it will offer a lifetime of mobility and support.