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 Question: Is surgery always needed for an ACL tear?
Answer: Surgery is definitely not required for all ACL injuries. Partial tears, where the knee is stable on physical exam can be treated with rehabilitation and bracing. Some patients with complete ACL tears do not need a reconstruction. These are typically older patients with lower physical demands, who also do not participate in cutting or pivoting activities.
- Question: Can the ACL heal itself?
Answer: A complete tear of the ACL rarely heals for a combination of reasons: the location of the ACL inside the knee joint, a lack of blood supply and the amount of energy at the time of ACL trauma. The torn ACL may scar down to the intact PCL (located behind the ACL in the knee), but this does not produce ACL stability. Due to the fact that the ACL does not heal, primary or direct repair, where the torn ends of the ligament are sutured directly together, does not produce healing and is not considered an accepted treatment.
- Question: Why should the ACL be reconstructed?
Answer: Stability is the main reason the ACL should be reconstructed. This is necessary for two reasons. First, the ACL is needed for knee stability during sporting activities that involve cutting and pivoting. The second and most important reason to reconstruct the ACL is that ACL deficiency predisposes the patient to injury of other crucial knee structures. In other words, the only purpose of the ACL is to provide knee stability in order to prevent meniscal and cartilage injury. These types of knee injuries can eventually lead to degenerative arthritis of the knee joint.
- Question: What is the difference between a repair and a reconstruction?
Answer: A repair involves suturing the torn ends of the ACL back together. Although this technique has been attempted in the past, studies have found that true healing does not occur and the technique has generally been abandoned in favor of a reconstruction. A reconstruction involves taking a tendon from somewhere else and using it as a graft to replace (or reconstruct) the torn ACL. The tendon may come from either the patient undergoing surgery (an autograft tendon) or from a cadaver (an allograft tendon).
- Question: Which is the best graft to use for an ACL reconstruction?
Answer: There is no clear consensus about which type graft is best. There are advantages and disadvantages of many of the technical aspects of ACL surgery, including the number of incisions, the type of graft used, the type of fixation for the graft, and the type of post-operative rehabilitation protocols. The nation's foremost authorities on this subject have different opinions on the specifics. However, it is unanimously accepted that an unstable ACL deficient knee in an athlete involved in cutting sports should be treated by ACL reconstruction regardless of specific ACL technical issues. It is generally agreed that the surgeon's experience with the specific chosen ACL technique and the patient's commitment to post-operative rehabilitation are more important factors in determining ACL outcome than specific graft type and fixation.
- Question: When can I play sports again after an ACL reconstruction?
Answer: Most patients can start to return to their sports between six to nine months after reconstruction. This is determined by surgeon preference and rehabilitation protocols. The area of post-operative ACL management is constantly changing and the time to return to play continues to shorten as both operative techniques and rehabilitation evolve. Studies show that some athletes can return to full activity sooner than six months, but these same studies also show a significant increase in re-injury to the surgically reconstructed ACL.
- Question: Is an MRI always needed to diagnose an ACL tear?
Answer: No, an MRI is not always required to diagnose an ACL tear. Physical examination alone can usually accurately diagnose an ACL tear. At times when accurate physical examination is difficult, i.e., an acutely swollen and painful knee, an MRI can help with the diagnosis. Typically, an MRI is used to confirm the diagnosis already made on physical exam, and to help identify associated injuries, such as meniscal tears, cartilage injuries, and tears of other knee ligaments (MCL, PCL).
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