ACL (anterior cruciate ligament) injuries are common in pivoting sports that involve quick changes in direction like soccer, tennis, football, or basketball. ACL tears don’t heal on their own, and usually require surgery to fully restore knee function. Explore the top treatments for ACL injuries, including a new innovative procedure known as Lateral Extra-Articular Tenodesis (LET) which has been shown to improve outcomes.
Dr. DiGiulio is an ACL expert and one of the only surgeons in the Triangle who performs LET surgery for ACL injuries.
ACL Reconstruction
ACL reconstruction is the gold standard for treating a torn ACL. This procedure involves replacing the damaged ligament with a graft from the patient or a donor. The most commonly used grafts include:
- Patellar Tendon Graft: This involves taking a section of the patellar tendon along with a piece of bone from the kneecap and the shinbone. It's known for its strength, quick integration, and faster rehabilitation but may cause anterior knee pain in some patients. The Patella tendon is the gold standard graft choice for younger patients and especially athletes.
- Hamstring Tendon Graft: This method uses strands of tendon from the hamstring muscles. It results in less postoperative pain and has a high success rate, although not as good as a Patella Tendon Graft.
- Quadriceps Tendon Graft: A newer option, this involves using a portion of the quadriceps tendon. It’s beneficial for patients who have had previous knee surgeries or need a larger graft.
- Allograft: In some cases, a donor graft (allograft) is used. This technique has excellent results in older, less active patients or those undergoing revision surgery.
Lateral Extra-Articular Tenodesis (LET)
Elite/professional athletes, young patients, or those with hypermobility are at higher risk of re-tearing the ACL after surgery. For these high-risk patients, LET is a valuable adjunct to ACL reconstruction. LET involves reinforcing the lateral side of the knee with additional tissue to provide extra stability. This technique addresses rotational instability, which can contribute to ACL graft failure. Strong data shows that combining LET with ACL reconstruction reduces re-injury rates and enhances overall knee stability.1
“Internal Brace”
An Internal Brace is another adjunct to ACL Reconstruction Surgery. In the early phases of healing, the ACL is fragile and vulnerable to reinjury. This technique involves adding an internal support adjacent to the ACL to reduce stress on the graft while it’s healing. For nearly all ACL surgeries, Dr. DiGiulio uses this technique.
Bridge-Enhanced ACL Repair (BEAR)
A relatively new procedure, BEAR uses a bioengineered scaffold to facilitate the healing of the torn ACL. The scaffold is placed between the torn ends of the ACL and is infused with the patient’s blood to promote natural ligament healing. This method aims to restore the ACL without needing a graft. This technique is experimental but has shown early promise for the future.
In the dynamic world of sports and active living, sustaining an ACL injury can be devastating. But with the right treatment, rehabilitation, and determination, you can return to the activities you love. Stay informed, stay positive, and most importantly, stay active! Consult with Dr. Milan DiGiulio, an Orthopaedic Sports Medicine specialist to determine the best course of action for your injury.
Milan M. DiGiulio, M.D. offers comprehensive orthopedic care for you and your entire family, specializing in Sports Medicine and arthroscopic surgery of the shoulder and knee. Dr. DiGiulio performs over 200 arthroscopic shoulder and knee surgeries each year, using the most advanced surgical technology. Dr. DiGiulio is an advocate of non-invasive, non-surgical treatment options such as Physical Therapy and Orthobiologics.
