Anterior Cruciate Ligament (ACL)

by Dr. Al DeSimone, M.D.

Anterior Cruciate Ligament (ACL) ruptures remain one of the most devastating injuries to the young competitive athlete. The ACL is the major supporting ligament within the knee joint that provides stability to the knee during running, cutting and twisting sports. Though a traumatic collision with another athlete can cause a rupture to the ACL, a sudden alteration in speed and/or change in direction can also predispose an athlete to this injury.

Often the athlete will describe a loud popping sensation within the knee joint and experience severe pain, swelling and weakness with the inability to ambulate. Diagnosis is usually made by obtaining a proper history of injury and by performing a thorough clinical examination of the involved knee. X-rays and MRI’s are extremely helpful during the evaluation of this injury and will often help rule-out concomitant injuries to the adjacent ligaments, menisci and/or cartilage. The goal of treatment is to return the athlete back to his or her prior level of activity, including competitive sports. Rarely, one may consider conservative, non-operative treatment for those that are extremely sedentary and inactive in athletics. In this incidence, treatment may include rehabilitation, bracing and restriction to certain activities. In those individuals who are competitive athletes and participate in high- demand twisting sports, surgical ACL reconstruction is the treatment of choice.

Over the last several years, I have seen numerous patients with surgical failures from prior ACL reconstructions that have been referred to my office for further consultation and revision surgery. Having performed over 1,700 Anterior Cruciate Ligament reconstructions and over 200 revision surgical procedures, I remain convinced that this procedure is extremely technical and should be treated with state-of-the-art surgical technique with attention to detail. Though re-injury may be a common cause of failure subsequent to ACL reconstruction, technical failures are commonly seen and can often occur from improper graft selection, tunnel placement, graft tension, and/or methods of fixation. The timing of surgery and proper postoperative instructions, including the return to athletics, also play a significant role in the prevention of re-injury. In concordance with the literature, barring any anatomical or growth related considerations, I prefer to utilize bone-patella tendon-bone autograftfor the young, high-demand athlete.

Treatment of the young competitive athlete who sustains an Anterior Cruciate Ligament rupture continues to be a challenging problem for the community, high school, or collegiate athlete. It is imperative that the athlete (and parents) understand the importance of pursuing treatment by an experienced surgeon with a subspecialty interest in knee ligament reconstruction. Failure to do so may predispose an athlete to additional surgery and the inability to return to sports in a timely fashion.