ACL Repair Options You Need to Know

ACL Repair Options You Need to Know

ACL-Repair-Options

ACL-Repair-Options

You’re sitting at home constantly thinking about your knee waiting for your results to come back after your MRI. It’s been a few days and you just want some closer so that you can proceed to the next step. Your phone rings and your doctor gives you the news you don’t want to hear, “The MRI results for your knee came back positive for a torn ACL.” After your moment of sadness sinks in, you proceed to ask your doctor different questions about your ACL surgery. The main topic your doctor will explain is the different types of ACL repair options for your injured knee. ACL repair is simply repairing the slightly torn ACL, and ACL reconstruction is replacing the completely torn ACL with a new ACL. In most cases with common small talk, these are normally referred as the same general meaning to “fix the acl.” The different types of acl repair options require using a “graft” as the replacement for your new ACL.You might ask, “What is a graft?”A graft is a living piece of tissue that is transplanted surgically. The different types of acl grafts one can choose from is an allograft, hamstring tendon graft, patellar tendon graft, quadriceps tendon graft and a prosthetic tendon graft. Let’s look at the benefits and risks involved in each option for repairing your acl. But, before we proceed, it is important to know that each one of these options have successfully healed all athletes of all ages, especially pro-athletes, back to performing at the highest level in sports. The types of acl repair options given to you will be based on your age, your athletic requirements, previous injuries and so on.

ACL Repair Option: Which ACL Surgery is Right for Me?

ACL Repair Options: What’s The Difference Between Autograft and Allograft Surgery?

ACL Repair Option: What is an ACL Allograft?

ACL_Repiar_Options_Allograft

ACL_Repiar_Options_Allograft

An ACL tendon provided from a cadaver. This choice of surgery is normally not recommended to those that play competitive sports. Instead, the donated acl is for those that play sports recreationally. Studies done by an orthopedic surgeon in Massachusetts, Dr. Jonathan Cluet, notes that an allograft is not as strong as a patient’s own tissue. However, from personal experience, I have done both my surgeries with an allograft and recovered 110% healthier than I was before.

Benefits:

  • An ACL allograft is a fast operation as it does not require the cutting of other tendons from your leg to replace the acl.
  • Less amount of incisions and pain after surgery.
  • Additionally, if the knee were to require an acl revision, you’ll have the option to do an autograft.

Risks:

  • Through out history, allografts have been known to be of poor quality and a significant risk of disease transmission. However, techniques have dramatically improved to make lower this risk.
  • The process of preparing a graft requires freeze-drying, which kills white blood cells and decreases the strength of the tendon

ACL Repair Option: What is an ACL Patellar Tendon Graft?

ACL_Repair_Options_patellar_tendon_graft

ACL_Repair_Options_Patellar_Tendon_Graft

A small incision from your own patellar tendon to use as your new acl. Your patellar tendon is located at the front of your knee that connects to your knee cap and shin bone. The central 1/3 of the patellar tendon is removed along with a piece of the bone from each that is still connected as one whole piece. This piece is about the same size as your acl( about 9-10mm). It suggested that those with chronic patellar pain, arthritis of the joint or workers that consistently bend their knees due to the pain following this repair option.

Benefits:

  • Preferred by surgeons as the patellar graft resembles and functions very similarly to your acl.
  • The pieces of the bone that are connected to the patellar tendon is placed inside the knee with drills to your knee bones to allow a bone-to-bone healing process, which by many surgeons, is the most effective healing process compared to other healing processes.
  • After 6-8 weeks, the patellar tendon that was removed is regenerated(grows back).

Risks:

  • Patellar fracture or patellar tear following this process.
  • Pain and complications in front of the knee where your patellar tendon was removed.
  • Due to the pain, atrophy(loss of muscle) is morel likely to happen, which may require prolonged physical therapy.
  • Bigger incision with a with a permanent loss of feeling about 2-3″ to the side of the incision.
  • Increased rate of long-term patellofemoral pain or patellar tendonitis

ACL Repair Option: What is an ACL Hamstring Graft?

ACL_repair_options_ACL_Hamstring_graft

ACL_repair_options_ACL_Hamstring_graft

Taking pieces of your hamstring that are bundled together to be used as your new acl. This method of graft has gradually improved. In younger athletes who have torn their acl’s but still have open growth plates, the hamstring graft is desirable.

Benefits:

  • Smaller incisions than the patellar tendon graft.
  • Less pain in the front of the knee and down the road compared to that of a patellar tendon graft.
  • The hamstring graft has been shown to withstand aggressive rehab, and early return to sports.
  • Said to be 250% stronger than the normal ACL.

Risks:

  • Since this method doesn’t utilize the bone-to-bone healing process, A longer healing process for the hamstring graft to be strong and rigid. This is due to it’s fixation of the graft in your bone tunnels. Approximately 10-12 weeks to heal to bone. The graft must be protected during this time if the fixation is not strong.
  • soft tissue-to-bone takes longer to heal than bone-to-bone healing, which athletes and physical therapists must be aware of for fear of an accelerated rehab without letting the bone tunnels to heal properly.
  • Damaging nerves and tendons in the are of dissecting the hamstring tendon is possible.
  • The hamstring tendon isn’t as likely to regrow like the patellar tendon. When athletes are fulling healed, they still have a 10% loss of performance due to this stripped tendon.

ACL Repair Option: What is an ACL Quadriceps Tendon Graft?

ACL_Repair_Options_ACL_Hsmstring_Graft

ACL_Repair_Options_ACL_Hsmstring_Graft

A piece of your quadriceps tendon is harvested just above the knee cap with one end of the tendon still connected to your knee cap. This graft is placed horizontally across the knee as opposed to vertically.

Benefits:

  • Great alternative to your acl if you have already had a previous patellar tendon graft or hamstring graft.
  • Lower risk of patellar tendonitis symptoms upon returning to sports and can normally your knee without much discomfort.
  • Less harvest site morbidity.
  • Larger cross sectional area of graft.

Risks:

  • Complications and pain associated to the location of the removed quadriceps tendon.
  • Fixations of the graft like other procedures creates a challenge.
  • Graft only has a bone block on one end of the graft.

Which Graft is Best for ACL Reconstruction?

Now that you understand the different types of acl repair options, you should focus on how each part of your legs feel. Are you confident in either your hamstring, patellar tendon or quadriceps tendon to remove this piece as your new acl? Does each part feel strong and healthy? Have you had previous issues with these parts? If you don’t want to risk the idea of making another incision and worrying about two parts of your leg (acl,semitendinosus) then an allograft would be your choice. However, I am a bit biased towards a cadaver acl graft due to my experience coming back feeling 110% healthier, stronger and faster. For someone that bends a lot, patellar tendon graft may not be your graft option. For those that sprint a lot and make sudden stops, hamstring graft might not be your best choice. Stipulations like this are things to evaluate when choosing your new acl. After learning about the different types of acl repair options, it really comes down to what you feel most comfortable with as your surgery, with regards to what your surgeon may recommend. But, always remember that your choice of acl does not predetermine your outcome, your mindset and motivation will determine your outcome.

 

Sources:

Center For Orthopaedics- ACL Graft Choices

ACL Surgery Graft Options

Graft Choices For ACL Reconstruction

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4 Responses

  1. Abdulrahman says:

    Hi doctor,
    Thanks for all of these good information and easy to understand .
    In the last part ‘ Which Graft is Best for ACL Reconstruction?’
    you mentioned both ‘ patellar tendon graft’ & ‘hamstring graft’
    but not ‘Quadriceps Tendon Graft’ can you give us some feedback .
    Thanks & appreciate.

    • egrabin says:

      Hello,

      There is information listed towards the bottom of the blog post that goes over Quadriceps Tend graft, but no video.

  2. Edmund says:

    Hi EGRABIN,

    I was wondering if you had reply to the question asked by “Abdulrahman” which I would like to know more about the “Quadriceps Tendon Graft”;
    As I will be needing to undergo an ACL Reconstruction

    Thank You and Best Regards

    • egrabin says:

      Hello,

      There’s information regarding the quadriceps tendon graft towards the bottom, but no video about it.
      A piece of your quadriceps tendon is harvested just above the knee cap with one end of the tendon still connected to your knee cap. This graft is placed horizontally across the knee as opposed to vertically.

      Benefits:
      Great alternative to your acl if you have already had a previous patellar tendon graft or hamstring graft.
      Lower risk of patellar tendonitis symptoms upon returning to sports and can normally your knee without much discomfort.
      Less harvest site morbidity.
      Larger cross sectional area of graft.

      Risks:
      Complications and pain associated to the location of the removed quadriceps tendon.
      Fixations of the graft like other procedures creates a challenge.
      Graft only has a bone block on one end of the graft.

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