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Thursday, June 18, 2009

Knee Surgery: Anterior Cruciate Ligament Reconstruction

By Dr. Stefan Tarlow

An Overview of ACL Reconstruction

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.

Surgery is chosen with such factors as the patients level of activity, age, and the stability of the knee in mind. Additionally, it is necessary to know if other knee structures have experienced damage. Surgery will normally be recommended when it will let the patient return to the previous level of activity.

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.

ACL reconstruction is always performed arthroscopically. My personal preference is to use an autograft-tissue graft. This is a graft that is harvested from the patient. It is also possible to use an allograft, which is harvested from a cadaver.

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 ACL keeps the knee stabilized and stress at a minimum across the knee joint.

The ACL prevents an excess of forward movement of the tibia (lower bone of the leg) in relation to the femur (thigh bone).

Excessive rotational motion of the knee is also kept under control by the ACL.

Click here to learn more about Dr. Stefan Tarlow, a leading Phoenix Knee Doctor.

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