ISSUES

Timing of Surgery

It is important to wait 3-4 weeks after your injury to have a torn ACL reconstructed. This allows the inflammation to settle down and for the patient to regain full motion of the knee. The reason to wait is if the ACL is reconstructed immediately, the patient has a greater chance of developing a severe stiffness of the knee known as arthrofibosis. At times, the swelling receeds quickly and the surgery can be done sooner.



Graft Choices

Many different choices are available for reconstructing a torn ACL. The two most common are ones that use your own tissue: Patellar Tendon and Hamstring Tendon Grafts. These are known as AUTOgrafts because the graft material comes from the patient. ALLOgrafts are forms of tissue that come from cadavers. The most common forms of allograft are Patellar Tendon and Achilles Tendon.

There is a trend toward greater use of allograft tissue. Published studies differ on what is the best graft material for a given patient. Each has advantages and disadvantages that a patient should discuss in detail with his or her surgeon of choice.


Techniques of Reconstruction

Several different methods of reconstruction are presently in use.

Open

This version of ACL reconstruction involves fully opening the knee. It may still be useful in certain cases but is rapidly being replaced by arthroscopic techniques.

Arthroscopic Assisted

In this technique, the arthroscope is used as a visualization tool and aids the surgeon in the placement of your graft. Typically, it is done via two incisions, one on the front of your knee and one on the outside of the lower part of your thigh.

Endoscopic

In this procedure, the knee is never formally opened. All of the work is done arthroscopically. You may still, however, require superficial incisions for graft harvesting.

Regardless of the exact type of reconstruction or graft a patient selects, it is important to review the inside of your knee for damage to internal structures other than the ACL. About 50% of the time patients who tear their ACL will also have torn their meniscus (a type of cushioning cartilage). These tears are typically addressed at the time fo the ACL surgery but at times may need to be dealt with prior to actual ACL reconstruction.


Hospitalization

Most ACL surgery can now be done on a outpatient basis. This is due to the less invasive techniques that cause significantly less pain. At most, a patient may require 1-2 days in the hospital.

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