ACL Reconstruction

Many graft options exist for anterior cruciate ligament reconstruction. Graft options include autografts taken from the patient, allografts from a donor, and hybrid grafts. Graft choice is crucial. Autografts are the preferred graft choice for younger patients and patients who lead an active lifestyle. Optimal graft type is one of the most important decisions in ACL reconstruction.

Choosing the right graft

Each graft has unique features, advantages, and disadvantages. Ultimately the graft choice is individualized based on multiple factors including:

• Evidence from high quality research studies
• Patel’s experience
• the patient’s age
• the patient’s sports activity level
• the mechanical demands on the reconstructed knee
• the associated graft failure rates
• donor site damage
• the patient’s prior surgery, extent of the injury and their goals and preferences.

Each patient will have unique injury characteristics and expectations. Therefore, the goal is always to determine the optimal graft for the individual.

With proper care and planning, complications as a result of ACL reconstruction surgery are rare but not totally uncommon. These complications can include:

• Allergic reactions to medications
• Infections (approximately 1 in 200 patients)
• Deep vein thrombosis, or clotting
• Swelling and bruising
• Stiffness
• Graft failure
• Nerve damage
• Continued pain

Dr. Ronak Patel takes precautions against all these risks, and this lowers the complication rate. Dr. Patel uses pre-operative antibiotics, compression stockings and blood thinners when necessary, meticulous surgical technique to enhance graft fixation, and accelerated rehabilitation.

Several studies suggest it is optimal to wait 3 weeks from ACL injury to prevent the risk of knee stiffness after surgery. This is flexible and revolves around obtaining full extension and flexion in the knee prior to surgery.

Two exceptions are 1) the elite athlete in which time to return to play is critical and 2) if there is a displaced meniscus tear that will not allow a full range of motion.

Studies also suggest that it is best to perform ACL reconstruction within one year of injury.  A higher rate of meniscus and cartilage injury is seen inactive individuals who have an unstable knee and continue to perform high level activities.  This can potentially contribute to early arthritis.