Medical Edge from Mayo Clinic

DEAR MAYO CLINIC:

I'm 45 years old and active in many types of athletics (running, biking, tennis). I injured my ACL, and I think I need surgery. What type of doctor do I see for ACL surgical repair? What does the surgery involve?

ANSWER:

For an anterior cruciate ligament (ACL) injury, you should see an orthopedic surgeon, preferably one who specializes in sports medicine. The surgeon can evaluate your condition and help determine if surgery is necessary. If it is, ACL surgery involves reconstructing the ligament. Full recovery from ACL surgery can take anywhere from six to 12 months.

The ACL connects the thighbone (femur) to the shinbone (tibia). It's an important ligament because it helps stabilize the knee joint. A torn ACL is a common knee injury that can make the knee unstable and feel as if the knee will "give way" during twisting or pivoting movements.

To diagnose a torn ACL, the surgeon assesses your symptoms and performs a physical exam that tests the knee's range of motion and stability. The knee will be X-rayed and, in many cases, a magnetic resonance imaging (MRI) scan -- a painless procedure that uses magnetic fields to create an image of the body's soft tissues -- will also be done. The X-rays and MRI can not only confirm an ACL tear, but they also can show any damage to other ligaments or to the cartilage in your knee.

If your ACL is torn, the need for surgery is based mainly on your symptoms and activities. If you have persistent knee instability, or if you want to engage at a high level in sports that involve pivoting, cutting and jumping (singles tennis or basketball, for example), surgery is often the best option. That said, if you don't have ongoing instability, then knee-strengthening physical therapy combined with use of a knee brace may be enough to allow your return to recreational activities. If, despite strengthening exercises and a brace, you can't get back to a suitable activity level, then surgery is a reasonable option. An ACL tear is unlikely to heal without treatment.

Because a torn ACL can't be reliably sewn back together, surgical repair involves reconstructing the ligament by taking a piece of tendon from another part of your leg (autograft) and connecting it to the thighbone and shinbone. If your own tendons don't provide the best replacement for the injured ligament, your surgeon may recommend using a tendon from a cadaver (allograft). In people older than 40, an allograft is more common, because that procedure involves less surgery and provides a slightly easier recovery.

Following surgery, you'll need to use crutches for about two weeks. With physical therapy, you'll likely be able to start jogging again in approximately three months. Most people can resume previous activities at six to nine months after ACL surgery.

I recommend that you see an orthopedic surgeon for an evaluation of your ACL injury. A thorough assessment of your condition and symptoms, along with a discussion about the type of sports you want to continue participating in, and the level at which you want to compete, will determine the appropriate treatment.

Diane Dahm, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.

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