ACL knee injuries are common among athletes, and can occur during daily activities.
The anatomy of the knee, does not allow the ACL to heal on its own, due to a poor blood supply, as well as the environment that the joint fluid (synovial fluid) creates. While not all knee damage requires surgical management of an ACL injury (see non-operative management), surgery is recommended for most patients. The decision for surgery is based on age, activity level, associated meniscal injuries, associated ligament injuries, and future fitness goals for patients.
Approximately 50 percent of ACL injuries occur in combination with another ligament, damage to the meniscus, or to the articular cartilage. For these situations, surgery is usually recommended. Your physician may recommend ACL reconstruction for patients ages 40 or younger. This recommendation is to lower the the risk of further meniscus injury, which can lead to arthritis of the knee. Many patients over 40 years of age may also be candidates for reconstructive surgery. This includes individuals who perform pivoting activities, such as athletes, individuals with outdoor jobs, or those who are frequently active on an uneven surface. If a patient wishes to continue partaking in activities such as hiking, fly fishing, walking or running on unstable ground or uneven terrain, surgery may also be advised to prevent knee instability. Finally, inactive patients may also need surgery if buckling of the knee is taking place during daily activities.
The 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.
Advances in arthroscopic knee surgery and ACL reconstruction techniques, coupled with a progressive and supervised rehabilitation program, allows patients to achieve a full recovery.