ACL Repair vs. ACL Reconstruction
Currently, evidence supports ACL repair for specific injuries to the ACL where it is torn directly off the bone insertion. If it is torn in the middle of the ligament, reconstruction is the supported treatment.
- ACL repair – the torn ACL is reattached.
- ACL reconstruction – a graft taken from the patient’s body or a tissue bank will be used to replace the damaged ligament.
ACL repair means the ligament will be reattached to its insertion on the femur (thigh bone) or tibia (shin bone) with specific devices and allow it to heal. Reconstruction, on the other hand, will require using a graft. The surgeon will review the graft options with you and is based on several factors.
The decision to undergo surgery may depend on the patient’s baseline physical activity level, age, functional demands, overall health, occupation and other existing injuries. Athletes or highly physically active individuals may be more inclined to choose surgery to get them back to their usual physical activities as soon as possible. On the other hand, patients may decide not to undergo surgery if they don’t have a very active lifestyle or participate in sports that require a lot of pivoting or cutting maneuvers. These patients may be able to function normally even without surgery.
ACL Injury Treatment
In general, ACL injury treatment is guided by your level of activity and desire to return to sports or an active lifestyle. Other factors, such as presence of osteoarthritis or general health, will also play a role. Treatment goals include:
- Restore knee stability and reduce pain
- Improve knee range of motion
- Prevent other knee problems from occurring
Your doctor will recommend appropriate treatment options after thoroughly examining your knee, the extent of its damage and other medical factors. Each treatment option has different benefits and risks, so ask your surgeon as much information as possible to help prepare you better.
Most patients wishing to return to sports or higher demand activities may opt for surgery. On the other hand, nonsurgical management of ACL injury may be enough for patients with less active lifestyle.
ACL Surgery Recovery
Patients can go home within the day of the surgery. Your doctor may recommend wearing a knee brace and using crutches after surgery, the duration will depend on any additional procedures done during the surgery. Typically, no longer than 6 weeks if a meniscus repair was performed, 8 weeks if cartilage surgery or as short as 2 weeks if just the ACL was reconstructed. Physical therapy may last up to 12 months. While it is important to stick to the physical therapy routine, tell your therapist if you feel pain or something feels wrong. Physical therapy is not a “no pain, no gain” approach. Pushing yourself too much through pain can do more damage and delay your recovery.
How soon you can go back to your usual physical activity will depend on the kind of movements your activity requires. In general, rehabilitation from an ACL repair or reconstruction may take up to 12 months. This may be longer if you do not consistently perform the prescribed exercises that will build the strength necessary to safely return to sport or activity. This is also a progressive process, so you will be active throughout and not just doing exercises. For example, at 4- 6 months after surgery we want our patients working through increasingly demanding sport-specific motions and form. From there, we work to optimize your strength and safeguard your knee.
