By Joseph Tauro, MD. Follow on Twitter @OCSM
Injuries to the anterior cruciate ligament (ACL) in the knee remain one the most common and serious injuries to athletes and can occur at any age. With hundreds of thousands of ACL injuries reported each year, OCSM has become a leader in providing excellent care for patients requiring treatment for ACL tear and sprains.
The ACL is a critical link between the femoral and the tibial sides of the knee joint, providing the knee with much of its stability. The ACL is responsible for controlling the back and forth motion of the knee, preventing the tibia from sliding out in front of the femur, and providing rotational stability to the knee
When the ACL tears, that connection is lost and the knee becomes unstable.
Someone who has an ACL tear can usually walk pretty well in a straight line after the acute swelling and pain from the initial injury subsides. The problem is that any planting and pivoting on the leg may cause an abnormal shift to occur, i.e. “pivot shift”, causing the knee to give away and possibly damaging other important structures in and around the knee.
For this reason, ACL reconstruction is often performed for complete tears in individuals who want to remain active. ACL tears typically cannot be simply sewn back together because the ligament stretches and ruptures in a way that completely destroys the mechanical strength of the original ligament.
When we “reconstruct” an ACL, we use a graft that acts as a scaffold into which the patients own cells migrate and ultimately form a new ligament. This graft can be the patient’s own tissue (which for us is the hamstring tendon or quadriceps tendon).
The latest and most exciting developments in ACL surgery revolve around new techniques which allow us to make the ACL reconstruction more anatomically correct and thus provide more normal function of the knee.
Arthroscopic ACL reconstruction was first developed in the late 1980s and involved a basic technique of drilling a hole into the tibia from the outside in and then going through that hole to drill a second hole in the femur. The graft is then pulled into those holes and anchored in place (“transtibial technique”). The technique, which is still in use today, uses a graft that is more vertical, controlling front-to-back stability of the knee, but only partially restores rotational stability:
To better control rotational stability, we use a new technique that places the femoral hole in a natural, more horizontal orientation:
Ocean County Sports Medicine (OCSM) recently performed an ACL surgery on a 50-year-old very active athlete and skier. We are proud to report her surgery went very well and we are confident she’ll be back on the slopes next year!
For more information on ACL injuries and their treatment, a great source is the American Academy of Orthopedic Surgeons website. For a more technical explanation of the technique we use and the rational behind it and a scietific discussion of the techniques available click on any of the links below:
- Technique for creating the anterior cruciate ligament femoral socket: optimizing femoral footprint anatomic restoration using outside-in drilling.
- Advantages and Disadvantages of Transtibial, Anteromedial Portal, and Outside-In Femoral Tunnel Drilling in Single-Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review.
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