Thursday, January 2, 2014

from the Doctor's Desk: ACL Reconstruction

ACL (Anterior Cruciate Ligament) Reconstruction Surgery

There are several options for ACL reconstruction.  These options include graft choice options and technique options.  Regarding graft choice (where we get the tissue to make a new ACL), there are two primary categories, either from the patient’s own tissue (autograft) or from a cadaver (allograft).  I typically recommend autograft ACL reconstruction as studies show very good results in athletes and non-athletes with autograft tissue, and there is no risk of disease transmission.

When discussing autograft choices, there are three typical options:
  1. hamstring tendon (from the inner side of the knee)
  2. patellar tendon (below the kneecap)
  3. quadricep tendon (above the kneecap). 
Each of these graft choices has shown to provide good outcomes for over 80% of patients.  Each has significant positives and a few potential negatives such as the potential for pain or weakness at the site of the graft harvest.
Image courtesy of AAOS

When discussing technique options there are two primary considerations, the position of the attachment points of the new ACL in the knee and how the ACL is secured to the bone.  The prevailing concept for the graft position is that we want to reproduce the patient’s anatomy.  Therefore, during the surgery, we place the new ACL attachment points by making sockets in the bone at the location of the previous ACL’s “footprint” as much as possible.  This anatomic positioning decreases the chance of the new ACL tearing or being unstable.  Once the graft is positioned appropriately, we then secure it.  There are several options, such as using screws or small metallic “buttons”.  In general, the more secure the fixation, the better chance the graft has of healing and getting the patient back to a healthy lifestyle.

My standard technique and graft choice is with an autograft   This allows for the rehabilitation process to start quickly and often with less pain than other options.
Image courtesy of Arthex
hamstring and a relatively minimally invasive technique for creating the sockets.

click here to watch a video on ACL reconstruction video.

Dane Glueck, MD – January 2014 

There is a fine line between blogging and giving medical advice. The content of this blog is for informational purposes only and should not be construed as medical advice.  Nothing contained in this blog is intended to replace the medical advice of a trained, licensed physician.
In all matters relating to your health, you are urged to consult a physician. You can contact Advanced Bone & Joint to set up a formal consultation appointment with Dr. W. Anthony Frisella, Dr. Dane Glueck, Dr. Brandon Larkin, Dr. Anthony Lombardo, Dr. John McAllister, II, Dr. Brian Meek, Dr. Paul Spezia, Jennifer Eickhoff, FNP-BC, or Matt Pliske, PA-C

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