“All Inside” ACL Reconstruction
The anterior cruciate ligament (ACL) is the primary stabilizer of the knee in activities that require cutting, jumping, or twisting. It is the “safety-belt” of the knee. Unfortunately, it is commonly injured in sports such as football, basketball, soccer, lacrosse, skiing and other similar activities. Tearing the ACL is usually a major traumatic event for the knee, and can result in significant additional trauma to the knee. Surgery to reconstruct the ACL must accomplish five goals: a sufficient graft material must be found to substitute for the ACL, it must be put in the correct location in the knee, it has to be tensioned appropriately to allow normal knee mechanics, it has to be fixed on the tibia and femur rigidly to allow early rehabilitation, and it must be put in the knee in such a way to avoid stress on the graft that could limit motion of the knee or lead to early failure of the graft. Traditional techniques use either the patellar tendon as a graft or two of the hamstring tendons. While both of these grafts have been shown to stabilize the knee, they each have what is described as donor site morbidity. Patellar tendon grafts often result in anterior knee pain and difficulty kneeling, while hamstring grafts may result in slight weakness of flexion. Furthermore, some patients especially those of smaller stature tend to have smaller hamstring tendons and we know from the literature that patients with graft less than 7.5 mm in diameter have a higher failure rate.
A novel minimally invasive technique has been developed that allows ACL reconstruction through tiny incisions, smaller drill holes in the bone of the femur and tibia, anatomic reconstruction of the ACL, and with the use of a single hamstring tendon. This results in less pain both early and later on in the recovery. The graft is folded onto itself twice creating a quadruple strand tendon which results in a larger hamstring graft, with less donor site morbidity, less tissue trauma, and less swelling. Since only one hamstring tendon is used, the remaining intact knee flexor muscles are also stronger and this definitely plays a role in restoring normal mechanics and function to the knee when returning to sport. This “all inside” technique has been shown to have similar results returning even high level athletes back to their sport and hopefully with larger grafts we will see a lower recurrence rate of ACL tears in long term studies.
If you have an ACL tear and are interested in learning whether or not you are a candidate for the minimally invasive “all inside” ACL reconstruction technique, please contact us at 616-459-7101 ext 1413.