5 Key Tips for Understanding ACL Reconstruction

June 2017 – “It is highly likely you know someone who’s torn their ACL (anterior cruciate ligament), one of the four main ligaments in the knee and a ligament that’s vital to the knee’s stability and normal movement. But for many people, ACL reconstruction surgery is a hazier concept requiring more understanding,” according to orthopaedic surgeon Kevin D. Plancher, MD, founder of Plancher Orthopaedics & Sports Medicine.

The ACL is one of the most commonly injured knee ligaments, with about 200,000 such injuries occurring each year, according to the American Academy of Orthopaedic Surgeons. Half of those patients will most likely go on to have their ACL reconstructed, especially those who play high-risk sports such as football, basketball, skiing, and soccer as well as weekend warriors who are most affected by tears. In addition, the incidents of ACL tears in young females have been noted to be increasing.

Why is this injury so prevalent? “Partly because of the way the knee is put together,” explains Dr. Plancher, who lectures globally on issues related to orthopaedic procedures and sports injury management. “The ACL is in the middle of the hinged joint and one of its jobs is to provide rotational stability to the knee as well as to prevent the shinbone (tibia) from sliding out in front of the thighbone (femur) during vigorous activity or when landing from a height.”

“Its position and function make the ACL particularly vulnerable when someone quickly slows down in sports, along with abrupt movements such as cutting, pivoting, and out-of-control landings,” he says. “However, beyond this basic awareness, many people – athletes or not – don’t know more about ACL reconstruction, when it’s needed or how it’s fixed.”

What you need to know about ACL surgery
What facts about ACL reconstruction should we keep top-of-mind? According to Dr. Plancher, here are 5 key tips to understand and questions you might ask your physician if you are injured and suspect you may have an ACL injury:

1. Specific factors determine whether ACL reconstruction is necessary: Your doctor isn’t just relying on an educated guess when recommending ACL surgery. Indeed, a variety of factors combined make an ACL reconstruction surgery a logical choice. These elements would include a physical examination and results of an MRI scan; which evaluates the ACL and checks for injury to other knee ligaments or cartilage to support his or her suspicion. “These tests will add information to determine if the ACL tear is a partial or complete tear as well as where in the ligament it is torn,” says Dr. Plancher. “Complete tears are much more likely to lead to chronic knee instability, and if the ACL tear is combined with other knee damage, surgery is usually advised.”
2. Sewing a torn ACL back together just isn’t enough: “Simply stitching up the torn ACL won’t solve the problem because repaired ACLs typically have been shown in research from the 1960’s and 1970’s to fail over time with a few exceptions,” Dr. Plancher says. Instead, the ACL is usually replaced with a graft taken from a part of the patient’s body, such as the kneecap or hamstring tendon, or from a deceased donor. “These grafts are much stronger than what can be achieved by stitching up a patient’s torn ACL and surgical reconstruction success rates are extremely high,” he says.
3. Activity, not age, should determine if surgery is warranted: Some people with torn ACLs decide not to undergo reconstruction. But for active adults who want to remain so – especially if their sports or occupations require pivoting, turning, or heavy manual labor – surgery is generally recommended. “Continuing to function with a torn ACL places the patient at much higher risk of suffering from other types of knee damage, which is another strong consideration,” Dr. Plancher notes.
4. Physical therapy is part of the treatment plan, regardless of whether surgery takes place: It’s worth it to find out if physical therapy can restore the knee to feeling close to its pre-injury state, reducing pain and swelling and helping the knee feel more stable. These efforts may be supplemented by the use of a hinged knee brace. But even if ACL reconstruction surgery is needed, physical therapy will still play a major role in the patient’s rehabilitation – both beforehand, to help maintain maximum knee movement, and after, to promote rapid and complete recovery.
5. ACL reconstruction surgery is typically minimally invasive: Fear not if you believe that ACL reconstruction requires a big incision in your knee. Most often, the surgery can be done arthroscopically, a minimally invasive approach necessitating only a few tiny incisions around the knee rather than one long one. “Using an arthroscopic approach makes sense because it’s easy to see and work on knee structures and typically carries fewer risks than open surgery,” says Dr. Plancher, also a Clinical Professor, Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine in New York. “Physical therapy after surgery will get the vast majority of patients back in the game and make their knee feel as good as new.”

Kevin D. Plancher, MD, is a board-certified orthopaedic surgeon and the founder of Plancher Orthopaedics & Sports Medicine.

Plancher Orthopaedics & Sports Medicine is a comprehensive orthopaedics and sports medicine practice with offices in New York City and Greenwich, CT. http://www.plancherortho.com