In recent years, advancements in implant technology have brought ACL repair back into the spotlight, offering certain patients a chance to avoid reconstruction and preserve their native tissue. As a surgeon, one of the most frequent questions I hear is, “Can I have an ACL repair?” With this growing interest, it’s important to understand the indications, benefits, and limitations of ACL repair, and how it stacks up against the well-established option of ACL reconstruction. In this post, I’ll break down who may benefit from each procedure and explore the pros and cons of both approaches.
What Are ACL Repair and ACL Reconstruction?
ACL repair involves reattaching the torn ligament back to the bone, usually for tears that occur near the bone (proximal tears). The goal is to preserve the patient’s natural ligament, avoiding the need for grafts or donor tissue.
ACL reconstruction, on the other hand, is a procedure where the torn ACL is replaced with a new ligament, typically harvested from the patient’s own body (autograft). Reconstruction is the traditional approach and is widely used to restore knee stability and function.
Benefits of ACL Repair
One of the major advantages of ACL repair is that it eliminates the need for graft harvesting, leading to less post-operative pain and a faster return to daily activities, such as work or light physical exercise. By avoiding the complications associated with graft donor sites—such as the patellar, hamstring, or quadriceps tendons—patients reduce their risk of long-term issues like pain or weakness at the donor site. This also means recovery is generally smoother and shorter, allowing many patients to return to sports and higher levels of physical activity months sooner compared to those who undergo ACL reconstruction. Additionally, because the natural ligament is preserved, patients may benefit from maintaining more of their knee’s original biomechanical function.
Downsides of ACL Repair
Despite its advantages, ACL repair has a historically higher failure rate compared to ACL reconstruction. This is especially true for high-demand patients, such as athletes involved in competitive sports. Additionally, ACL repair is only suitable for certain types of tears—particularly those that occur near the ligament’s attachment to the bone (proximal tears). Tears in the middle of the ligament (mid-substance) or chronic injuries typically require reconstruction for long-term success.
Good Candidates for ACL Repair
The success of ACL repair is predicated on selecting the right candidates. Not all patients are candidates for this procedure. The following are the optimal candidates for ACL repair:
- Patients with acute ligament tears directly off the bone: Tears where the ACL detaches close to its attachment site on the bone and are relatively recent (acute) are prime candidates for repair.
- Recreational athletes: People who are active but not performing at a high competitive level may benefit from the quicker recovery associated with ACL repair.
- Patients needing a quicker return to everyday functions: Since there is no graft harvest involved, patients may experience less pain post-surgery, leading to a faster recovery and return to daily activities.
Benefits of ACL Reconstruction
One of the key benefits of ACL reconstruction is the strength and durability provided by the graft, typically harvested from the patient’s own tissue, such as the patellar or quadriceps tendon. This procedure has a proven track record of success, especially in restoring knee stability for athletes and those with high physical demands. With decades of data supporting its efficacy, ACL reconstruction remains the gold standard for patients who require long-term stability and performance. This is particularly important for high-level athletes looking to return to sports at their previous performance level.
Downsides of ACL Reconstruction
Despite its benefits, ACL reconstruction comes with some downsides. The recovery process is longer, often taking 9-12 months for a full return to sports or strenuous activities. Additionally, if an autograft is used, there is a risk of donor site morbidity, which can lead to pain or weakness at the graft harvest site, such as the patellar or quadriceps tendon. This extended recovery and potential for complications at the graft site are important considerations when choosing this procedure.
Good Candidates for ACL Reconstruction
The success of ACL reconstruction relies on selecting patients who require the highest levels of knee stability and function, especially for high-level athletes or individuals with physically demanding jobs. Candidates for ACL reconstruction benefit from the strength and durability that the procedure provides. The following are the optimal candidates for ACL reconstruction:
- High-level athletes or high-demand individuals: Competitive athletes and those involved in high-demand physical activities need maximum knee stability, which ACL reconstruction offers through the use of a graft to replace the torn ligament.
- Patients with mid-substance or chronic tears: Tears located in the middle of the ligament or those that have become chronic typically cannot be repaired and require reconstruction for long-term stability and function.
- Individuals with physically demanding jobs: Patients whose occupations involve heavy lifting, quick lateral movements, or activities that place significant strain on the knee are better suited for reconstruction, as it provides more long-term stability and durability.
My Recommendation
In my practice, I generally recommend ACL reconstruction for high-level athletes who need the highest degree of knee stability and function for their sport. For recreational athletes or individuals who need to return to work or daily activity quickly, ACL repair may be a great option. Every case is unique, so it’s essential to discuss your goals and expectations with your surgeon to find the best approach for your specific situation.
For more information on ACL Injuries and treatment options click here.