Anterior Cruciate Ligament
Overview
The ACL (anterior cruciate ligament) is an important ligament that helps stabilize the knee joint. ACL injuries are common among athletes and can occur during activities that involve sudden stops, jumps, or changes in direction. These injuries can range from mild sprains to complete tears, often requiring surgery to return to twisting and pivoting sports.
ACL Tear Symptoms:
A loud “pop” or a “popping” sensation in the knee
Severe pain and inability to continue activity
Rapid swelling
Loss of range o motion
A feeling of instability or “giving way” with weight-bearing
Nonsurgical Treatment:
For less severe ACL injuries or for patients who are less active, nonsurgical treatments may be appropriate. These can include:
Rest and Activity Modification: Avoiding activities that exacerbate symptoms - including sports with jumping or rapid direction changes
Physical Therapy: Strengthening the muscles around the knee to improve stability.
Bracing: Using knee braces to provide additional support.
Anti-inflammatory Medications: Reducing pain and swelling through medications like ibuprofen.
Surgical Treatment:
When surgery is required, the primary goal is to restore knee stability. Ideally, this may allow the patient to return to their previous level of activity, potentially preventing further injury to the knee structures.
Methods for Surgical Intervention:
Direct Repair: Only possible in select types of ACL tears, such as an avulsion where the ACL pulls away from the bone and can directly be reattached.
ACL Reconstruction: Rebuilding the ACL with a graft (often taken from the patient’s own quadriceps, hamstring, patellar tendon or a donor graft).
BEAR (Bridge-Enhanced ACL Restoration): This technique utilizes a collagen-based scaffold (the BEAR implant) placed around the torn ACL to aid with ACL healing. This technique allows for preservation of native ACL tissue by encouraging the body’s natural healing process and reduces donor site morbidity as no graft tissue is taken.
All-Inside ACL Reconstruction
ACL reconstruction involves replacing the torn ACL with a graft. This has become the “gold standard” for treating ACL injuries.
Graft options include Autograft (patients own tissue) vs Allograft (cadaver donor tissue).
ACL Primary Repair
ACL repair involves suturing the torn ligament back rather than replacing with a graft. This is most commonly performed with an avulsion injury - where the ligament peels away from the bone. Typically, this can be repaired with sutures tied or attached to a button outside the femur (suspensory fixation) or by reattaching with a suture anchor directly into the bone.
BEAR Implant
Bridge Enhanced ACL Restoration is a newer innovation in ACL treatment that involves preservation of the native ACL tissue. The procedure involves suturing the ends of ACL tissue and utilizing a collagen scaffold to aid with ACL healing by creating a conducive environment for the torn ligament to heal.