When the ACL is torn, is can rarely be repaired. Surgery is
often required to reconstruct the ACL. If reconstruction is not performed, the
knee is at increased risk of cartilage damage, meniscal tear and
osteoarthritis. Especially in younger patients, surgical repair is recommended
following an ACL tear.
Surgery is performed
arthroscopically and the ACL is either repaired or replaced. If the torn ligament
cannot be repaired, the ACL is replaced with a tissue graft. The surgeon and
patient have the option to use autograft tissue or allograft tissue.
Autograft tissue is a tendon from another location on the
patient’s body. Most commonly a surgeon would use a hamstring tendon or
patellar bone tendon bone. With the patellar bone tendon bone, the middle third
of the tendon is removed and used as the new ACL.
Allograft tissue is a cadaver tendon that is taken from
another person. In this case, the surgeon would use the achilles tendon,
patellar bone tendon bone or a hamstring tendon.
Autograft is recommended for patients 30 years old or
younger. The failure rate of allograft tendons is much higher in those under
the age of 30 and the risk of infection is very low. The downside of using the patient’s tissue is that the operation
is more involved and painful. The surgeon must surgically remove the
autograft tendon and then also repair the ACL. The patient is undergoing two
procedures as opposed to one.
Allograft tendons are preferred in patients over the age of 30.
The advantage of allograft is that it involves less surgical time and is less
painful. The disadvantage of allograft is increased risk of infection and
rejection. It is important to mention that the advances in allograft testing and sterilization have improved significantly in recent years. Risk of infection and disease is
extremely low. Another advantage with allograft is that there are now numerous
options to choose from, which allows the surgeon some flexibility in deciding
which option is best for each individual patient.
In summary, if you are having surgery on your ACL, it is
best to talk to your orthopedic surgeon about which option is best for you.
Each case is unique and should be evaluated thoroughly before making a final
decision.
