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Types of ACL Surgery

ACL surgery is performed on the anterior cruciate ligament, which is located in the knee. The ACL is one of the most commonly injured ligaments, injured by an estimated 200,000 patients each year. Of the 200,000 annual ACL injuries, surgery is performed in approximately 100,000 cases.

  1. Who Should Have Surgery

    • ACL injuries can be treated without surgery, but many patients who do not elect that option. Surgery is most often considered to be the appropriate treatment method for patients who are young or active that can't or won't modify their athletic activities; for patients whose injury is severe enough to affect their performance of daily non-strenuous activities; or for patients with multiple injured ligaments. There is a great deal of post-operative care required after ACL surgery, so patients should be committed to following the proper procedures for recovery.

    Direct Repair

    • The direct repair method is one method of ACL surgery. The direct repair method involves using sutures to attach the torn ends of the ACL ligament to each other, so that they can heal on their own. This procedure is not widely used because it does not have the best results. According to Emory Healthcare, often the ligament does not heal completely or reliably following this procedure.

    Extra-Articular Procedures

    • Extra-articular surgery involves attempting to repair the ligament without actually reconstructing the torn ACL. The name of the surgery means "outside the joint" and describes the procedure, which occurs outside of the knee. A portion of a tendon, usually the iliotibial band, is secured outside the knee across the joint in order to make the knee more stable. However, because this tendon is outside of the joint, it does not work as well at stabilizing the knee as the ACL, so often the tendon interferes with normal knee function or does not really stabilize the knee. Although this procedure is used more frequently than direct repair, it is still not effective for these above mentioned reasons, so it is not used as frequently as an ACL reconstruction.

    ACL Reconstruction

    • An ACL reconstruction is the most common type of ACL injury performed, according to Emory Healthcare, because it achieves the most reliable long term results. This surgery uses a graft (tissue obtained from elsewhere on the body) to replace the torn ACL. The graft then heals fully and functions as the ACL did, after a period of rest and therapy.

    When Should Surgery Be Performed

    • Regardless of the type of ACL surgery performed, the surgery should not be undertaken until the initial inflammation from the torn ACL has subsided. This means the surgery should not be performed until the knee is no longer swollen and a somewhat adequate range of motion has been achieved. Thus, prior to the surgery, extensive physical therapy may be required to get the knee and ACL into sufficient shape to undergo the procedure.

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