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Overview
Anterior cruciate ligament (ACL) reconstruction is the most
common type of surgery for a completely torn, or acutely/
chronic insufficient ACL with associated instability. Both these
cases can cause further complications in the patient. Repairing
the torn ACL by simply reconnecting the torn ends is possible
only in rare cases.
Nevertheless, ACL tear management is usually treated using
reconstruction. Most surgeons now favor reconstruction of the
ACL using a piece of tendon to replace the torn ACL.
A graft is used to replace the torn ACL. The graft can be
taken from elsewhere in the patient's extremity (autograft),
harvested from a cadaver (allograft) or may be synthetic.
Autograft
Autograft is the most widely performed orthopedic ACL
reconstruction. The technique involves moving the patient’s own
tissue. Surgeon preference is the primary factor in selection of
the tissue.
Allograft
An allograft is tissue that is harvested from a cadaver.
(Donor tissue is kept at a tissue bank where it is screened for
infection and then stored-most commonly frozen.)
Advantages are obvious:
No donor site morbidity
Less operative time.
Synthetic
The advantages of synthetic grafts are the lack of harvest
site morbidity, off the shelf availability, and no disease
transmission. However, the failure rates of synthetic grafts
were unacceptable. Synthetic grafts currently have inherent
mechanical properties that do not closely resemble the normal
ligament and as they are not living, they cannot repair
themselves, as can natural ligaments.
Recovery
During the first 3 or 4 days, efforts are directed at
minimizing the swelling and reestablishing quadriceps function.
During recovery time, cryotherapy and elevation of the knee,
leg and ankle are emphasized. Frequent movement increases blood
flow return from the extremity (e.g. ankle pumps).
Crutches are used to walk bearing weight as per doctor's
orders. The emphasis is on a normal gait without limping.
Wear comfortable shoes.
Stay within your safe range of motion as directed by your
doctor.
Bathe and shower after surgery as your doctor directs.
Autograft
Most surgeries are being done on an outpatient basis,
although some patients stay overnight. After surgery, you will
begin a rehabilitation program. The patient alone may do
rehabilitation, with a certified athletic trainer or with a
physical therapist. Formal therapy usually last 2-12 weeks and
then is followed by a “home program” which will last until full
strength and agility are achieved which usually takes four to
six months. Following the rehabilitation, you may be placed on a
return to sport program using a functional progression approach.
Allograft
The course after allograft is the same as autograft except
that patients often experience less pain in the first week or
two allowing an earlier return to light duty work or school.
Successful ACL reconstruction is dependent on a number of
factors, including surgical technique, post-operative
rehabilitation and associated secondary ligament instability. |
