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Anterior Cruciate Ligament Tear - Treatment
Treatment for Anterior Cruciate Ligament (ACL) Tear
If you have a tear in your anterior cruciate ligament (ACL), you may need surgery to repair or replace the ligament.
Surgery for Anterior Cruciate Ligament (ACL) Tear
The treatment for an ACL tear is typically a surgical reconstruction to replace the torn ligament with a new graft of tissue. However, an ACL does not always require surgery. A few patients decide not to have surgery and can function fairly well without an ACL in their knee. These patients tend to be less active and do not participate in activities that require pivoting and jumping motions with the knee.
You and your surgeon will discuss your options together. Consider your activity level when making this decision, so that you fully understand both sides of the decision.
Most people who tear their ACL cannot safely return to activities they enjoy because the knee remains unstable. This instability leads to pain, swelling and damage to other structures in the knee, including the cartilage and the meniscus (cartilage cushions that function as shock absorbers).
Types of Surgery to Treat ACL Tear
Once you have decided to undergo surgery, you have various options depending on your individual needs. In rare circumstances, the ACL can be repaired such that your original ACL is left in place and stimulated to heal.
Nearly all completely torn ACLs are damaged in such a way that they need to be replaced with a new graft of tissue rather than a repair. Your surgeon can use various techniques and types of tissue to replace your ACL, with different benefits to each. You will need to discuss the procedures in detail with your surgeon, so that together, you can reach the appropriate solution for your particular needs and wishes. Your decision will depend on:
- Your surgeon's training and preference
- Your wishes
- The type of sport or position played
The types of grafts include:
Autograft (your own tissue from another location)
- Patella tendon (harvested from the front of your knee)
- Hamstring tendons (harvested from the side and back of your knee)
Allograft (human donor tissue from a tissue bank)
- Patellar tendon
- Achilles tendon
- Hamstring tendons
Each option has different benefits and disadvantages that you should discuss in detail with your surgeon.
ACL Surgery: What to Expect
The surgery itself is "arthroscopically assisted," meaning that the surgeon performs most of the procedure with an arthroscope (microscopic camera). The surgeon uses the standard tiny incisions, but typically makes an additional incision of approximately one inch for placement of the graft. The goal of the surgery is to recreate the normal path of the ACL to provide the necessary stability.
The procedure takes usually about an hour to perform and is an outpatient surgery (no hospital stay). By performing the arthroscopy at the same time, the surgeon can directly view the entire knee joint, enabling treatment of any other associated injuries, such as meniscus tears.
During the surgery, we will:
1. Place the ACL graft by routing it through small tunnels that are created in the femur (thigh bone) and tibia (shin bone).
2. Use various fixation techniques to hold it in place. The specifics of the fixation technique depend on the type of graft that you and your surgeon have chosen.
ACL Surgery: Recovery
The rehabilitation process takes several months. When you can return to your regular activities varies based on the surgeon, the surgical technique, the type of activity you are returning to and even the type of graft used. Therefore, the timing of the surgery is often important for many athletes to be able to return to play in a timely manner. Most athletes return to full activity at nine to 12 months after the surgery.
Learn more about the ACL and how an anterior cruciate ligament tear typically happens.
Clinical Trials
Clinical trials are research studies that evaluate a new medical approach, device, drug, or other treatment. As a Stanford Health Care patient, you may have access to the latest, advanced clinical trials.
Open trials refer to studies currently accepting participants. Closed trials are not currently enrolling, but may open in the future.