ACL Reconstruction Surgery - Dr. Scott Meyer
Dr. Scott Meyer discusses ACL reconstruction surgery.
"During the ACL surgery, a patient will have a general anesthetic. We usually do what's called an ‘examination under anesthesia’ to confirm the ACL tear diagnosis, as well as any associated collateral ligament injury. We then do a diagnostic arthroscopy. We're looking all over the knee and treating any cartilage problems (meniscus cartilage tearing or articular cartilage injuries) – that might affect the postoperative rehabilitation and recovery progression.
Then we move on to the reconstruction once that ACL injury is confirmed. The camera on the arthroscope allows us to look around inside the knee. Instruments direct the tunnel making in the bones of the tibia and the femur. We get the ACL placed in an anatomic location within the knee – and then within those tunnels we place a graft. It's usually some type of a tendon graft. We might use what’s called an autograft, which means it comes from the patient's same knee or some doctors might harvest from the opposite knee. That commonly might be a hamstring tendon, patellar tendon graft or a quadriceps tendon graft. We commonly now recommend using an autograft for high-level athletes because they have a lower re-tear rate compared to allografts.
Allografts can be used and have a little bit less pain initially because you do not have the harvest site pain of the graft procurement. Allografts still work well in the less vigorously active athlete. Someone over age 35 might be an appropriate indication for an allograft. An allograft would allow a busy person probably to return to work a little sooner because it's a little bit less pain in the short run. Different grafts might be indicated for different purposes and surgeon preference has a high impact on which graft might be utilized as well.
ACL reconstructive surgery is usually done as an outpatient surgery. We usually put people in a leg brace – and they'll be on crutches for as long as needed. If there's no meniscal, cartilage or collateral ligament work patients can usually be allowed weight bearing as tolerated. But as part of the pain management, we usually provide crutches and the brace. We start moving the knee right away the next day or even the day of surgery if the patient wants." - Dr. Scott Meyer
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