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When Does an ACL Tear Require Surgery?

When Does an ACL Tear Require Surgery?

Surgery is typically the last thing a specialist considers when treating musculoskeletal conditions that cause chronic pain or affect your mobility. But a surgical fix may be your best option for an ACL tear if you’re active and want to maintain full pain-free mobility.

Sumit Dewanjee, MD, is a leading orthopedic surgeon in practice at FXRX Orthopaedics & Bracing in Tempe and Chandler, Arizona. Dr. Dwanjee specializes in minimally invasive procedures that offer outstanding results with a quicker recovery and return to an active lifestyle than traditional or open surgery.

Our FXRX team explains what happens when you tear the ACL and why a surgical fix is often the best remedy for this common injury.

Understanding the anterior cruciate ligament (ACL)

The ACL is one of two cruciate ligaments within your knee joint that attach your shinbone to your upper thigh. The cruciate ligaments cross behind the kneecap (patellar), with the posterior cruciate ligament at the back and the anterior cruciate ligament forming the front portion of an X.

The ACL controls the back-and-forth motion of your knee, preventing the shin (tibia) from slipping in front of the thigh (femur) and providing stability when you rotate the knee. 

ACL injuries are common in sports, especially those that include:

Anyone who is active is at increased risk of an ACL injury, which can occur during your Saturday morning run or with an awkward stumble during an evening walk that causes the ACL to stretch and tear.

Damage to cartilage and other structures within the knee joint can also occur during an ACL injury or from ongoing knee instability related to an undiagnosed or untreated ACL tear.

Why would I need surgery for an ACL tear?

ACL tears, also known as sprains, are graded according to their severity:

Grade 1 sprain

A Grade 1 sprain or tear indicates the ligament has stretched but is still tight enough to provide knee stability and will generally heal over several weeks with activity modification, bracing, and other conservative treatments.

Grade 2 sprain

Often called a partial tear, a Grade 2 sprain stretches and loosens the ACL enough that the ligament loses its stabilizing nature.

Grade 3 sprain

A Grade 3 ACL sprain, often called a complete tear, occurs when the ligament snaps apart and loses function.

Unfortunately, most ACL injuries are complete or nearly complete tears. Neither can heal effectively without surgery because ligaments are poorly vascularized. This means they don’t have the blood vessels that carry oxygen, growth factors, and other nutrients necessary for tissue repair. 

A less active (often senior) individual may respond well to bracing, crutches, or other assistive devices to aid ambulation following an ACL tear. But most ACL injuries require a surgical graft to restore knee stability and pain-free mobility.

What happens during ACL surgery?

ACL repair varies according to the nature of the tear, your overall health and activity level, and your future sports goals. At FXRX, Dr. Dwanjee develops surgical strategies based on an extensive evaluation and discusses details of the procedure before scheduling your surgery.

Generally, Dr. Dwanjee performs minimally invasive ACL repair (knee arthroscopy) that may include:

Single bundle ACL reconstruction

Dr. Dewanjee uses a tendon graft during single bundle ACL reconstruction to reconstruct the ligament. This traditional procedure provides knee stability and flexibility while eliminating pain and the risk of further damage to other tissue structures within the knee joint.

Double bundle ACL reconstruction

Double bundle ACL reconstruction is a more advanced procedure requiring two smaller tendon grafts. Typically resulting in improved knee stability and movement, this procedure may be a better fit for highly active individuals.

Both procedures are outpatient surgeries requiring no overnight hospital stay, followed by a customized rehabilitation program designed to return you to full activity as soon as possible.

For more information about ACL repair or any service we offer, schedule an evaluation at FXRX today. Call the office or request an appointment using our secure online service.

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