The ACL prevents anterior translation and rotation of the tibia below the femur. When torn the ability to decelerate and change direction is compromised with meniscal injuries likely to occur in the untreated knee. There are no braces that are effective at high performance levels, thus surgery is the only practical way to treat this injury in a high level athlete
Surgery should be delayed until the inflammation has subsided and full ROM restored. If there is an associated meniscal tear that can be repaired,the best results are with a staged procedure-meniscal repair followed by ACL reconstruction with inspection of the repair. Staged procedures are not commonly done because of the added expense and delay in treatment of the ACL tear
There are several ways to reconstruct the ACL using autologous(patient's own tissue) grafts or donated tissue. In the elite athlete the "gold standard" is the traditional bone-patella-bone graft. A segment of the patella and tibia are harvested along with the central 1/3 of the patellar tendon. The graft is routed through a tibial tunnel with one bone segment fixed in a femoral socket and the other in the tibial tunnel. The patellar tendon becomes the new ACL but it takes about 6 months for the patient's cells to infiltrate the graft converting it to a "ligament"
The other commonly used graft is a combined hamstring tendon graft but recent studies have shown that there is a reduction in performance once those tendons are harvested. The incorporation of the graft into the bony tunnels is also less reliable.
Donated tissue from carefully screened deceased can also be used but the incorporation takes longer and failure rates have been higher because inadequate time has been given for recovery/rehabilitation. A larger graft can be used but tunnel incorporation and graft maturation takes longer. This is an ideal form of treatment for the older weekend warrior who has no timeline to return to competition
This should only be construed as general information and should not be considered related to CT's injury
Surgery should be delayed until the inflammation has subsided and full ROM restored. If there is an associated meniscal tear that can be repaired,the best results are with a staged procedure-meniscal repair followed by ACL reconstruction with inspection of the repair. Staged procedures are not commonly done because of the added expense and delay in treatment of the ACL tear
There are several ways to reconstruct the ACL using autologous(patient's own tissue) grafts or donated tissue. In the elite athlete the "gold standard" is the traditional bone-patella-bone graft. A segment of the patella and tibia are harvested along with the central 1/3 of the patellar tendon. The graft is routed through a tibial tunnel with one bone segment fixed in a femoral socket and the other in the tibial tunnel. The patellar tendon becomes the new ACL but it takes about 6 months for the patient's cells to infiltrate the graft converting it to a "ligament"
The other commonly used graft is a combined hamstring tendon graft but recent studies have shown that there is a reduction in performance once those tendons are harvested. The incorporation of the graft into the bony tunnels is also less reliable.
Donated tissue from carefully screened deceased can also be used but the incorporation takes longer and failure rates have been higher because inadequate time has been given for recovery/rehabilitation. A larger graft can be used but tunnel incorporation and graft maturation takes longer. This is an ideal form of treatment for the older weekend warrior who has no timeline to return to competition
This should only be construed as general information and should not be considered related to CT's injury
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