ACL Injuries

by admin May 20, 2010

Written by Edward M. Jaffe, M.D.

The Anterior Cruciate Ligament (ACL) is one of the most important structures that provide stability to the knee. When the knee is forced into positions that stretch the ACL beyond its normal length, this important ligament can tear. These injuries may occur during sports, typically while changing directions with the planted foot not rotating or during a collision with the force on the outer (lateral) or front (anterior) part of the knee. Often times the tear is accompanied by an audible “pop”.

The most common symptoms after an ACL tear include pain, swelling of the knee, and an inability to bear weight. Once the initial swelling and pain resolve, typically after a few weeks, there is often a sense of instability or “giving way” of the knee.

Once the initial pain and swelling have resolved and knee motion has improved, your orthopedic surgeon can help you decide on the treatment option that is best suited for you. As the technique of surgical reconstruction for torn ACLs has improved, along with refined post-operative physical therapy methods, more and more people opt for surgical reconstruction. The primary indications for surgery are a desire to return to an active lifestyle or continuing knee instability with normal daily activities.

Since a torn ACL will not heal on its own, surgical treatment requires replacement of the torn ligament with another structure. My surgical technique for reconstructing knees with torn ACLs has evolved over the years. Early on I would use a portion of the patients own patellar tendon with attached bone fragments. Over the last couple of years I have treated about one hundred patients with a technique that uses a strand of cadaver tendon that is twice as strong as the previously used patellar tendon. These tendons are obtained from organ donors and are provided in sterile conditions from companies that are accredited by a national organization of tissue banks. Surgical techniques provide secure fixation of the tendon graft which allows early weight bearing. The incisions with the new procedure are cosmetically desirable (less than one inch in length), and the patient goes home the same day as surgery. Patients that had the older technique on one knee and the newer technique on the opposite knee greatly appreciate the decreased pain and quicker recovery period. The newer techniques have greatly improved the surgical and recovery process for patients with ACL injuries.

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