The anterior cruciate ligament (ACL) is a frequent victim of injury among athletes and non-athletes alike. If this ligament is torn, most people, especially young and active people, benefit from surgery to restore the ligament. For a select few, Dr. Pace may be able to offer ACL repair. But for most patients, at least for now, the more conventional option of ACL reconstruction is the appropriate choice.
The term “ACL reconstruction” is used because this surgery literally involves rebuilding, or “reconstructing” a torn ACL. Tissue taken from somewhere else is used to create a new ligament. This tissue can come from you (called “autograft”) or from a cadaver (“allograft”). While it would be nice to use tissue from someone else, the numbers tell us that the re-tear rate for allograft tissue for ACL reconstruction is higher than what it is for your own tissue. Thus, for the young athlete, autograft tissue is almost universally recommended. Allograft tissue still has a place, but it plays a limited role for most young patients.
There are three principle autograft choices: bone-patellar tendon-bone, hamstrings, and the quadriceps tendon. While any of these tissues, or “grafts”, can give a patient an excellent new ACL, there are a few things to think about. The patellar tendon graft has a high rate of “donor site morbidity”. In other words, it can create problems in the spot where you took it from. The hamstrings don’t create as many problems in that regards but sometimes they can be quite small and small ACL grafts have a higher rate of retearing. The quadriceps tendon mitigates both of these problems because it is the largest tendon in the knee and it can be harvested in such a way that there is little to no donor site morbidity. With new technology, this graft can be harvested through a very small, cosmetic scar. At this point, Dr. Pace uses the quadriceps tendon almost exclusively, including for skeletally immature patients.
Contact our office now at (860) 837-9220 to set up an evaluation and consultation to discuss all your ACL injury options.