ACL Repair vs Reconstruction
Although ACL reconstruction surgery has been the gold standard of treatment for ACL tears, certain types of ACL tears can be repaired, thus preserving one’s normal anatomy. If an ACL tears in the middle of the ligament, these injuries still require ACL reconstruction surgery and currently cannot be repaired with any high degree of success. However, in some ACL tears, the ligament fibers pull away from their attachment on the femur. These particular types of tears can be repaired and a more invasive reconstruction can be avoided.
With ACL reconstruction, the entire torn ACL is removed from the knee. Bone tunnels are drilled in the femur and the tibia and a tendon graft (usually taken from the patient and less commonly from a donor as donor tendons retear more easily) is then anchored into these bone tunnels. Although ACL reconstruction surgery leads to very good outcomes in the majority of cases, around 15% of ACL reconstruction surgeries fail with retearing of the ACL graft. Dr. Cunningham has performed thousands of arthroscopic ACL reconstruction surgeries, but most ACL reconstruction surgeries are done by surgeons who do less than 20 ACL reconstruction surgeries a year. If the surgery is not performed properly, one’s graft can more easily retear and there can be other damage to the knee such as meniscus tearing which can lead to early arthritis in the knee joint. In addition, a redo or revision ACL reconstruction surgery has an even lower success rate, and the recovery time is typically one year to return to all activities.
Whenever possible, it is best to try to preserve your ACL and have it repaired. ACL repair can be done if the ligament tears up at the top of the ACL. One of the biggest benefits of ACL repairs is the elimination of the graft harvesting process. By not having a piece of tendon removed from around your knee and instead repairing the native ACL, patients have a quicker recovery compared to reconstruction surgery. Other ACL repair benefits compared to ACL reconstruction include:
- Conservation of blood vessels and nerves to the ACL
- No tunnel drilling or removal of bone from the femur and tibia
- Preservation of the exact attachment sites of your ACL to the tibia and ACL
- Restoration of the exact sized ACL you had
- Marked decrease in muscle atrophy compared to reconstruction surgery
- Full return to sports in half the time it would take following ACL reconstruction