The Anterior Cruciate Ligament (ACL) is important for maintaining the stability of the knee joint, particularly in activities involving pivoting or kicking. The knee becomes unstable with a ruptured ACL and the joint may become more damaged over time. ACL reconstruction is the surgical treatment of choice to restore stability at the knee joint. However, some basic principles may guide your requirement or non-requirement of ACL reconstruction surgery.
Non-operative treatment may be considered if you:
- Have minimal or no anterior tibial subluxation
- Have no additional intra-articular damage
- Are older in age and not very active
Operative treatment is preferred if you:
- Have a marked anterior tibial subluxation
- Have additional intra-articular damage
- Are younger in age and very active
What is ACL reconstruction surgery?
The goals of reconstructive surgery are to restore stability and to maintain a full active range of motion. There is no single standard technique for ACL reconstruction. Each surgeon has a different technique and preference. Different techniques include arthroscopic vs open surgery, intra vs extra-articular reconstruction, femoral tunnel placement, number of graft strands, single vs double bundle, and fixation methods.
There can be two different techniques used for ACL reconstruction:
Extra-articular – was commonly performed for anterior tibial subluxation to eliminate any pivot shift. It has, however, lost favour due to residual instability and the later development of degenerative changes. When used alone it has a high rate of failure.
Intra-articular – Intra-articular reconstruction has now become the preferred choice. This procedure can be performed with both an endoscopic technique or a double incision arthroscopic technique. Various tissues/grafts have been used to anatomically reconstruct the torn ACL. These can all be used as autografts i.e grafts taken from the person undergoing surgery. Other methods include the use of allografts and synthetic ligaments.
You may consult Dr. Biren Nadkarni, a leading Orthopedic and Joint Replacement Consultant Surgeon at Joint & Bone Solutions in Delhi. He is associated with Holy Family Hospital and Sitaram Bhartia Institute of Sciences and is one of the best Orthopedic surgeons in Delhi with a rich experience of nearly two decades.