The ACL (anterior cruciate ligament) is one of the four major stabilising ligaments in the knee. It is commonly injured in sporting activities such as netball, basketball, rugby and soccer. It can also be torn in non sports-related injuries. The ACL has poor healing potential and a tear usually results in an unstable knee. Instability can result in further injury to important structures in the knee. This may have negative effects in later years…
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Do I need surgery to fix the ACL?
The answer depends on your age and levels of activity, the amount of instability that you have, and the general condition of your knee. ACL reconstruction is almost always recommended for a young person with an ACL tear. It may also be recommended for patients of any age who have otherwise healthy knees. This is true especially if they enjoy being active or if they have symptoms of instability. An ACL reconstruction is generally not recommended if there is significant arthritis in the knee.
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Why do I need ACL surgery?
The problem with the ACL is that once it is torn it does not heal. Sometimes the torn ligament can be re-attach to the bone but unfortunately it’s normal function is usually lost. The result is an unstable knee which “gives way”.
People with an ACL tear often complain of a sensation of the knee partially dislocating. This is noticed especially when you do twisting or pivoting movements. Having an unstable knee can result in damage to other structures in the knee such as the meniscus. The meniscus is a supporting cartilage in the knee which acts like a “shock absorber”. A meniscal tear or injury, especially in a healthy knee, can result in the development of painful arthritis (osteoarthritis). Having an unstable knee as a result of an ACL tear can put you at risk for developing a meniscal tear. This can cause arthritis in the knee in later years.
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Can the ACL be repaired, or must it be reconstructed?
Arthroscopic picture of ACL tear
The difference between ACL repair and ACL reconstruction is that in a repair we reattach the original torn ligament to the bony surface where it tore off. A reconstruction involves removing part or all of the original ligament and replacing it with a substitute, called a graft. The graft is usually a tendon borrowed from another place in your knee. The graft may also be obtained from other donors (allograft) and synthetic grafts are also available.
Through the years surgeons have tried new techniques to perfect the technique of repairing the ligament. Unfortunately this has not resulted in overwhelming success. A repair is therefore not the gold standard treatment. A reconstruction is therefore the tried and tested method to restore stability to your knee.
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In summary…
If you have an ACL tear it is recommended that you be see an ACL surgeon familiar with the intricacies of this procedure. This should be done as soon as possible to discuss the correct treatment. Delays of a few weeks can result in significant injury to the knee. This can have profound effects in years to come. I have had many years training in this particular procedure and it is an operation that I enjoy doing. The operation is done arthroscopically (“keyhole surgery”). The following article may also be useful: ACL reconstruction – four questions answered.
Yours in good health,
MB BCh (Wits), MRCS (England), MMed (Ortho Surg), FC Orth (SA)
Orthopaedic Surgeon
(011) 304 6784
About the author…
I am an orthopaedic surgeon with a special interest in sports injuries and minimally invasive (arthroscopic) surgery of the knee and shoulder. I treat patients at Waterfall Hospital in Waterfall/Midrand and Morningside Mediclinic in Sandton. Besides these, I also treat patients from other areas as well, including Rosebank, Sunninghill and Fourways.
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