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Tuesday, June 16, 2009

Knee Surgery: Reconstruction of the Anterior Cruciate Ligament

By Dr. Stefan Tarlow

ACL Reconstruction: An Overview

The ACL (anterior cruciate ligament) stabilizes the knee. It is easily torn because of its location and the extent of activity and stress the knee joint is subjected to on a regular basis. The choice to treat ACL damage with surgery is an individual choice.

It is based on such factors as how much damage the rest of the knee structure has suffered, the stability of the knee, the patients activity level, and the patients age. If surgery will allow the patient to return to the pre-injury activity level, it is usually recommended.

ACL reconstruction can stabilize the knee and prevent further damage to the articular cartilage and the cartilage cushions, known as the menisci. It can also help in preventing premature knee deterioration.

Across the board, ACL reconstruction surgery is performed arthroscopically. Personally, I believe that an autograft-tissue graft that comes from the patient is the best thing to use. The alternative is an allograft. This is a graft harvested from a cadaver.

However, I think allografts are subject to problems. Recent research has indicated that patients under age 25 who receive an allograft followed by an aggressive rehabilitation program are 10-25% more likely to have problems.

Click here to learn more about knee arthroscopy.

I prefer to use Patellar Tendon Autograft with interference screw fixation for patients below the age of 30 who have no underlying patellofemoral disease. Additionally, I prefer Hamstring Autograft (semitendinosis and gracilis combined) with a rigid extra-articular fixation - the Rapid Loc or Toggle Loc, for example - on the femur as well as the Washer Loc on the tibia.

If the patient is under age 25, I have been known to use an allograft as long as the patient guarantees he will not engage in aggressive, competitive sports for a full year following the surgery. This period of time gives the allograft a chance to heal. Also, I will use allografts when there is more than one ligament that needs to be reconstructed.

The ACL acts to provide stability for the knee and to keep stress at a minimum across the knee joint:

Excessive forward movement of the tibia (lower bone of the leg) in relation to the femur (thigh bone) is also prevented by the ACL.

Additionally, it prevents excessive rotational movement of the knee.

Click here to learn more about Dr. Stefan Tarlow, a leading Phoenix Knee Doctor. - 17273

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