The ACL is a ligament located in the front of the knee. It provides stability to the knee with rotational movements or twisting. The main function of this ligament is to prevent the bone in the leg from moving forward relative to the bone of the thigh.
The ACL is the most commonly torn ligament in the knee and in many cases is associated with athletic participation. When an individual tears their ACL, at the time the injury occurs, patients will hear a pop and will immediately feel pain and have swelling in the knee joint. In most cases, because the ACL typically does not heal on its own, ACL reconstruction surgery is performed to restore function to the knee. While the procedure is very successful, some patients will have a re-tear of the ACL and tear the reconstructed graft.
While the exact cause for a re-tear is not always fully understood it can be due to many circumstances. Some patients simply return to sports too soon, or did not take the necessary time to rehab the injury. Some will experience a new trauma (such as a fall or another sports related injury). Unfortunately, some patients will have a graft or fixation from the original surgery that failed. One a re-tear occurs, the knee once again is left unstable and must be carefully addressed to restore function to the knee.
In these cases, an ACL revision surgery will probably need to take place. This procedure is more difficult to perform because of the fact that at least one surgery has already failed and that the devices used to fix the first ACL are still in place in the knee.
Dr. Anz will assess the knee carefully and will order new X-rays and most likely an MRI to help understand why the initial surgery failed and check to see if there are any anatomical or other factors that put the patient at risk for tears or other predisposed risks. In certain cases a revision ACL reconstruction can be performed immediately using either a graft from the patient (patellar tendon, hamstrings) or a donated graft. This will all depend on the circumstances stemming from the first surgery (i.e. what graft was used, how it was placed, etc.). Dr. Anz may decide to perform the revision surgery in stages, especially if the quality of the bone in not strong enough or good from the first surgery. These stages will include a bone grafting procedure to fill the areas with new bone, followed by a revision ACL reconstruction with a graft 4-6 months later.
Patients will be prescribed a very strict and thorough rehabilitation program following revision ACL surgery. After surgery patients will be placed into a brace and will typically use crutches for 2 weeks. Even after therapy has concluded, Dr. Anz may recommend that a patient use a functional type brace once they return to activities for the first year.
The results of ACL reconstruction are highly successful in terms of restoring function and allowing patients to return to their activities. In cases of a revision reconstruction, the results are also very successful but less so than a primary surgery due to the complexity of the injury and procedure.
For additional information on revision ACL reconstruction surgery, or to learn more about common knee injuries involving one or more ligaments within the knee, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.