ACL reconstruction surgery is recommended for most patients who are diagnosed with a complete tear of the ACL, and for many patients with a partial ACL tear. In generally, ACL reconstruction is recommended for the following patients:
- Those who are 40 years old or younger
- Those who have meniscal injuries associated with the ligament injury
- Those who perform consistent pivoting activities, such as athletes
- Individuals with outdoor jobs
- Those who partake in activities on uneven surface (such as hiking, fly fishing, running)
- Inactive patients who have buckling during activities of daily living
In cases of multiple knee ligament tears, your physician may decide to recommend a brace, and wait 6 weeks, to determine if the associated injuries (such as medial collateral ligament-MCL-injuries), can heal without surgery. If the MCL heals, then the ACL reconstruction can be performed without the need for MCL surgery.
A meniscus tear is extremely common in patients who have ACL tears. If the meniscus is torn, the evidence-based best time to repair the meniscus is at the same time as the ACL reconstruction. Dr. Lubowitz has published that the best way to lower the risk of arthritis after ACL tear is to save the meniscus.
Another common injury that can occur in association with an ACL tear is damage to the bone lining called articular cartilage. Damage to these surfaces is very serious, and in some cases is the worst part of the injury. Cartilage damage may require associated treatment, which is usually performed at the same time as the ACL surgery.
Arthroscopic surgery for an ACL reconstruction uses an arthroscope, which is a camera smaller in diameter than a pen, with a fiber optic light source. The arthroscopy is placed into the knee through keyhole size incisions that allows your physician the ability to view the entire inside of the knee on a television monitor. Then, keyhole sized surgical instruments are used to repair damaged structures. Arthroscopic surgery is minimally invasive, with an evidence-based rapid recovery. Patients having arthroscopic ACL surgery participate in an accelerated rehabilitation process.
ACL reconstruction procedures use an ACL graft that will be anatomically positioned in the knee joint at the native site of the ACL footprint. It will then be secured to the thigh and lower leg bones with buttons or screws.
Dr. Lubowitz has pioneered and published, and now performs less invasive “all-inside”, “no-incision”, and “retroconstruction” ACL surgical techniques, which result in equal knee stability outcomes with evidence-based less pain. Minimally invasive, “all-inside” ACL was Dr. Lubowitz’ treatment of choice for most patients.
Following ACL reconstruction surgery, patients are able to go home the same day. A detailed set of post-operative instructions, as well as a well-planned physical therapy rehabilitation program will be prescribed.
ACL surgical technique is customized on a patient-by-patient basis based on age, activity level, activity type, and patient preferences. There are options with regard to graft choice, graft fixation, and other details of the surgical procedure that may lead to excellent results in the hands of an experienced ACL surgeon. These include: