ACL Reconstruction

How ACL reconstruction works

A torn anterior cruciate ligament is generally not stitched back together, because the ligament sits inside the joint and does not reliably heal end to end. Instead the ligament is reconstructed: a new one is built from tendon tissue and placed along the path the original took, so that it can again resist the shin bone sliding forward and help control rotation of the knee.

The operation is usually done arthroscopically, through small incisions, with a camera inside the joint. The remnants of the torn ligament are cleared, and the surgeon identifies the natural attachment points of the ACL on the thigh bone and the shin bone. Tunnels are made at those points, the graft is passed through them, and it is secured at each end so that it is held under appropriate tension with the knee in the right position. Over time the body remodels the graft, which is one reason rehabilitation is deliberately staged rather than rushed. Meniscus or cartilage injuries found inside the knee are commonly addressed at the same time.

Reasons people are referred for reconstruction

• A knee that gives way or feels untrustworthy on turning, cutting or uneven ground
• A complete ACL tear in someone who wants to return to pivoting sport or physically demanding work
• Repeated episodes of instability after an earlier injury
• An ACL tear together with a meniscus tear that needs repair, or with other torn ligaments
• A previous reconstruction that has failed and left the knee unstable again

How candidacy is evaluated

Before reconstruction is planned, the surgeon confirms the diagnosis on examination and imaging, checks which other structures are involved, and looks at the state of the knee itself. Swelling, stiffness and poor quadriceps control are generally addressed first, and preparatory rehabilitation is often recommended so the knee goes into the operation in good condition. Age, growth plates in younger patients, activity demands, other ligament injuries, leg alignment and earlier surgery all influence the plan. Your general health and your ability to commit to rehabilitation are part of the discussion as well.

Options in general terms

Reconstruction is not the only path, and the alternatives are worth understanding:

• Rehabilitation without surgery. A reasonable option for some people, particularly those willing to step away from cutting and pivoting activities.
• Bracing. Support that may be used alone or alongside rehabilitation.

When reconstruction is chosen, several decisions are made together with your surgeon:

• Graft source. Tissue taken from your own body, such as hamstring, patellar or quadriceps tendon, or tissue from a donor.
• Treatment of associated injuries. Meniscus repair or trimming, cartilage treatment, or work on other torn ligaments at the same sitting.
• Revision reconstruction. A more complex operation when a previous graft has failed, sometimes staged with bone grafting of old tunnels.
• Rehabilitation plan. A staged program that progresses through motion, strength, and sport-specific work, with return to activity guided by how the knee performs rather than by the calendar.

What to expect when you consult Dr. Wolfson

Dr. Wolfson is board certified in the United States and Canada and has treated sports injuries and orthopedic trauma throughout his career. A consultation covers your examination and imaging, the graft options, what else may need attention inside the knee, and what the rehabilitation commitment looks like. Complimentary phone consultations are available for patients outside the Bay Area.

This page provides general information about ACL reconstruction and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]