Can You Retighten A Repaired Acl

Tears of the anterior cruciate ligament or ACL have get commonplace on the ball fields beyond the world.  ACL injuries are normally treated with a reconstruction or a replacement of the torn tendon.  Should we exist repairing your ACL tear instead of replacing it with a graft?

Whether it is due to poor training, poor preparation, early single sports specialization, or only plain bad luck, the literature, and our feel will tell you that ACL injuries are increasingly more than common.   One time an ACL tears the athlete is looking at a long rehabilitation, a 25% chance of a re-injury, and only a modest risk of returning to their prior activities.  Unfortunately, the athlete is also looking a good adventure of developing arthritis down the road at a relatively immature age.  Nosotros are not exactly sure why the risk of developing arthritis is and so high with our current reconstruction techniques, and that is where a different approach to ACL tears might be worth looking into.

A word of caution before reading the rest. Recent data has given us reason to atmosphere our enthusiasm for straight repairs of ACL tears.  Read the last paragraph and yous can view the research on your ain.  Some recent studies suggest that up to 50% of ACL repairs fail.  We are awaiting the results of the Acquit trial which should requite us further clues every bit to whether or not a direct ACL repair is worth considering.

Why Should We Repair The ACL?

We have come a long way in terms of treating the ACL injured athlete.  For many, we tin can restore your ability to render to the playing field and remain agile. Unfortunately, a successful return to sports carries with it a virtually 25% chance of tearing your other ACL or the ane you had surgery to reconstruct.

Your normal ACL has special nerves in it.  These nerves provide proprioceptive feedback.  That means that the nerves in the ACL help you know the position of your knee in space without looking at your knee… your encephalon can sense where it is based on the proprioceptive nerve fibers. Anyway, information technology turns out that proprioception is condign a strong predictor of joint stability.  If we ameliorate your proprioception post-obit ankle sprains and other injuries your perception of joint stability improves.  This is also felt to be the reason why pinch knee joint sleeves work to improve your sense of knee stability.

When the ACL tears those special fretfulness are torn as well. Following a routine ACL reconstruction, the nerves practice non regenerate.  Therefore your new ACL does not contribute whatever proprioceptive feedback to your brain.  This might explain why many knees yet feel unstable, and it may explain, in part, the risk of developing osteoarthritis.

At that place are three pregnant reasons why an ACL repair might exist preferred over an ACL reconstruction.

1. We do not need to harvest a graft or tissue to use as your new ACL ligament.  Right now we take one of your hamstring tendons or a portion of your patella tendon.  That adds significantly to your pain. And it may contribute to issues afterwards surgery as well.
2. A successful ACL repair has been shown to enable those proprioceptive fretfulness to heal every bit well.  This might meliorate your sense of articulation stability and thus might improve the ability to return to sports and could theoretically diminish the risks of arthritic degeneration.
3. Near 25 % of you who tear your ACL have a run a risk of re-tearing the ACL once more.  A revision ACL reconstruction tin exist a technically challenging procedure with inferior results when compared to your initial reconstruction.  If we repair your ACL, so if you go along to re-tear your ACL it will be very straightforward to perform a reconstruction since we practice not have to drill os tunnels or alter your beefcake in any way to repair the ACL.

Can All ACL Tears Be Repaired?

No.. All ACL tears cannot be repaired.  The ACL is attached to your thigh os or femur and to your shin os or tibia.  Our electric current repair techniques merely allow u.s.a. to consider tears which occur loftier in the ACL nigh the femur insertion as a possible repair candidate.   Besides, the tear cannot exist too sometime.  If the tear is old, so the ligament will degenerate, and it may not be able to be brought back to the office of the bone information technology needs to be repaired to.  Lastly.. some ACL tears await similar the ligament exploded.  That leaves united states with very little feasible ACL tissue to repair.  In those instances, we may be able to perform a biological ACL Repair-Augmentation which I will draw in a moment.

What Are the Benefits of an ACL Repair?

In general, repairing torn tendons or ligaments is preferred over reconstructing them.  When we reconstruct a ligament, we use a tendon from somewhere else in your body, remove the remnants of the torn tendon and put the new tendon in place to "reconstruct" your new ligament. It is an imperfect solution for a difficult trouble.  In addition to the benefits, I discussed before, if a tissue is repairable and has been shown to heal well and enable a return to an active lifestyle so it would be preferable to having a reconstruction.

How Is An ACL Repair Performed?

If you injure your ACL and choose to proceed with  ACL surgery to improve your chances of returning to an active lifestyle, then nosotros have a few options to explore.  The potential benefits of an ACL repair are fairly clear.  I will embrace the potential downsides in a moment.  If you choose to consider an ACL repair, and then you understand that if your ligament is repairable, we will suture information technology dorsum into place on the femur.  Every bit we discussed, you may be a candidate for a repair since all ACL tears are not repairable.   If you are not a skilful repair candidate, and so nosotros will perform a routine ACL reconstruction or a biological augmentation.

What is a Biological ACL Repair Augmentation?

Certain ACL tears cannot be repaired.  If the ligament cannot be repaired, just a good portion of the ligament remains fastened to the tibia, then we can augment your torn ACL with a graft.  In this case, we proceed in a manner very like to an ACL reconstruction, only nosotros do not remove your torn ACL.  Instead, when nosotros put the graft into your human knee, we will identify information technology right through the center of your torn ACL.  That will allow your torn ACL to heal to the new graft. This reestablishes the normal "footprint" of your ACL, improves the blood flow to the graft, and it might allow those special nerve fibers to heal.

What Are The Risks of an ACL Repair?

The risks of any surgery apply to an ACL repair.  That includes the gamble of infection, stiffness, ligament failure, pain, claret clots, and the fact that the ACL might tear over again if you lot sustain another twisting or standoff injury.

And so, our treatment of ACL tears continues to alter and evolve.  The more we understand the biological science of the injury and the natural history of ACL injuries the meliorate we will become at returning you lot to an active lifestyle with minimal risk of developing long term problems such as osteoarthritis.   Perhaps paying more than attention to repairing ACL tears instead of reconstructing them will be a positive footstep along the evolutionary path of our treatment of ACL injuries.  Time will tell.

What are the results of a straight ACL repair?

There was a recent paper (2019) released regarding the results of an ACL repair versus a traditional ACL reconstruction.   The authors of this paper establish that near 50% of the repaired ACLs failed within the starting time two years.  This is a pregnant trouble.  We will need to expect the results of other studies before we make up one's mind if a straight ACL repair is a viable alternative for managing ACL injuries in an athletic population.

Howard J. Luks, Doc is an orthopedic surgeon & sports medicine specialist. An expert in shoulder, articulatio genus, and other sports injuries, he is widely known as one of the country'southward best orthopedic surgeons.

Source: https://www.howardluksmd.com/acl-tear-repair/

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