Ask a Vail Sports Doc: Save your ACL
Ask a Vail Sports Doc
Anterior Cruciate Ligament tears of the knee commonly occur in skiing and other cutting and pivoting sports. Historically, patients who suffer an ACL tear end up having ACL reconstruction surgery to stabilize their knee so that they could resume their sports. I am excited to now be repairing torn ACLs in certain patients instead of removing the torn ACL and reconstructing it with a tendon graft.
The goal of any intervention in orthopedic surgery is to restore the patient’s anatomy and function. Thus, in the majority of orthopedic injuries, we repair damaged ligaments, bone or tendons.
Back in the 1970s and 1980s, orthopedic surgeons repaired torn ACLs, but the results were poor. As a result, orthopedic surgeons abandoned ACL repairs and instead started to reconstruct torn ACLs in the knee by removing the torn ACL from the knee, harvesting a tendon from the patient, and then inserting this tendon graft into the knee in place of the torn ACL.
Only recently have a few orthopedic surgeons around the world revisited the idea of repairing one’s torn ACL and thus saving it. The results of current repair techniques are much better than the repair techniques of the 1970s and 1980s as today we have MRI, arthroscopy, better implants, better suture materials, better instruments and techniques, and improved rehabilitation protocols.
Less pain, shorter healing time
For the past two years, I have repaired a significant number of torn ACLs, and the results are very encouraging. Not every ACL tear is amenable to repair. ACLs torn away from the femur bone are good candidates for this repair technique whereas tears in the midsubstance of the ACL are still best treated with reconstruction utilizing a tendon graft.
ACL repairs are done arthroscopically, with a camera in the knee and using only a few small incisions placed strategically about the knee. Several strong lightweight sutures are threaded through the torn ACL with a special instrument and then these sutures and ACL fibers are secured to the normal ACL attachment site on the femur using two small nonmetallic suture anchors. Thus, the torn fibers of the ACL are secured back to where they tore away from and then stem cells from the bone seep through the hollow suture anchors and heal the torn ACL fibers back to their native bone attachment site.
There is much less pain after an ACL repair surgery as I am not having to harvest a piece of one’s hamstring, patellar or quadriceps tendon to use for the new ACL. I am also not having to drill tunnels in the tibia and femur bone to thread the graft into.
The healing time and the rehabilitation time is also much faster after ACL repair surgery than after ACL reconstruction surgery. My ACL repair patients are typically back to all their sports and activities in less than five months whereas ACL reconstruction patients are not cleared for all sports until nine months. I find that this is due to the fact that there is much less muscle atrophy after a more minimal ACL repair surgery compared to a more extensive ACL reconstruction surgery. There are now a number of studies in the orthopedic literature showing very good results following ACL repair surgery.
In summary, I am very excited to be offering this ACL repair technique in the Vail Valley as I think it will benefit our active population greatly and get them back to their activities much faster.
Dr. Rick Cunningham is a knee and shoulder sports medicine specialist with Vail-Summit Orthopaedics. He is also a physician for the U.S. Ski Team. Do you have a sports medicine question you’d like him to answer in this column? Visit his website at http://www.VailKnee.com to submit your topic idea. For more information about Vail-Summit Orthopaedics, visit http://www.vsortho.com.