What is an ACL Repair?
An ACL repair is an excellent option for certain types of anterior cruciate ligament tears. It is a procedure whereby the native ACL is preserved, repaired, and allowed to heal after tearing. It is different than the more common ACL reconstruction surgery. In ACL reconstruction, the torn and damaged ACL is completely removed from the knee and replaced with a tendon graft taken from the patient or a cadaver.
ACL repair was first performed back in the 1970’s and the results were poor. However, at that time the procedure was done through a large open incision, all types of ACL tears were repaired and not just those types where the ACL pulled away from its upper attachment on the femur, suture anchors had not yet been invented, suture material was not strong, and accelerated rehabilitation protocols had not yet been developed. Rehab at that time consisted of placing patients in a lower leg cast for 2 months and as a result knees got very stiff and scarred.
Current ACL repair techniques have vastly improved as have indications. ACL repair is a great option for those ACL tears where the ACL tears up high near its attachment to the femur. ACL repair is not indicated for ACL tears that occur in the middle of the ligament as these repairs do not heal well. The procedure is now arthroscopic, using three small ½” incisions. Small, strong, non-metallic suture anchors and high strength suture material is used to anchor the torn ACL back to the end of the femur bone from which it tore away. Patients follow an accelerated rehabilitation protocol under the guidance of an experienced physical therapist. The recovery and time to return to sports is much quicker than after ACL reconstruction surgery. Finally, results of primary ACL repair have been very good.
What is an ACL Reconstruction?
Anterior cruciate ligament ACL reconstruction is a surgical procedure that entirely replaces the ACL. The damaged ligament is completely removed from its native position. Reconstruction surgery requires a tendon graft. It could be a tendon taken from a cadaver, called an allograft, or it could be a portion of a tendon harvested from the patient, called an autograft. Dr. Cunningham recommends reconstruction with an autograft instead of an allograft, as re-tear rates are much lower with an autograft.
ACL reconstruction is performed arthroscopically. It occurs as an outpatient procedure. No hospital stay required. The patient receives a femoral nerve block to numb the leg for several days and then a light general anesthestic is administered. The surgeon makes several small incision and arthroscopic tools are inserted to remove the torn ACL and create sockets in the bottom end of the femur and top end of the femur where the ACL once attached. A section of one’s quadriceps tendon, patellar tendon, or hamstring tendons are then anchored into these bone sockets using strong suture material and small fixation devices. The wounds are sutured closed and a knee brace applied. The patient is taken to the recovery room. Typically, a patient spends a few hours in recovery, before being released home.
ACL Repair vs. Reconstruction
Key benefits when deciding between an anterior cruciate ligament ACL repair and ACL reconstruction are as follows:
- Elimination of the graft harvesting process (including recovery from the harvest)
- Minimally invasive with no drilling of bone tunnels
- Preserving the native ACL as well as the blood vessels that nourish it and the nerve fibers that innervate it.
- Better restoration of the normal biomechanics of the knee as the native ACL is preserved.
- Less pain and faster rate of return of range of motion, strength and function.
- Safer option in children with open growth plates compared to reconstruction
- If there is ever another injury to the knee with damage to a repaired ACL, an ACL reconstruction surgery is easily performed
- Very successful for the treatment of ACL tears.
- High rate of return to the previous level of function, strength and range of motion
- More painful with graft harvesting and tunnel drilling than ACL repair
- Slower recovery and return to sport than ACL repair
- Somewhat higher risk of developing arthritis in the knee depending on the status of the meniscus cartilages and the type of graft utilized.
Key considerations when deciding between an anterior cruciate ligament reconstruction or ACL repair are outlined as follows:
- Slightly higher risk for reinjury after repairing the native ACL vs ACL reconstruction
- Currently contraindicated for mid-substance ACL tears
- Still developing more long-term data from researchers on the outcomes of ACL repair
- A proven track record of restoring knee stability and function
- Higher risk of developing arthritis in the knee
- Increased pain, weakness and recovery time from the harvesting process vs. repair
What is Recovery Like after ACL Surgery?
After ACL repair and ACL reconstruction surgery, patients go home the same day. They are placed in a knee brace holding their knee straight and are partial weightbearing with the assistance of crutches. Patients can come out of the brace and start range of motion right away. In the first week, patients are icing and elevating the knee. Patients can shower over the knee after 72 hours from surgery. Physical Therapy commences after surgery with patients going 2-3 days per week and doing gentle home exercises on their own the other days. Patients progress more quickly after ACL repair compared to ACL reconstruction in restoring full motion and strength. Patient compliance during the recovery process will help ensure a complete healing and optimal outcome. ACL doctor Dr. Richard Cunningham specializes in performing both ACL reconstruction and ACL repair. Contact us today to learn more.