For those individuals who do not have surgery, they will likely wear a brace to stabilize the knee during activities. However, there are many complications associated with not repairing the ACL. Without a fully-functioning ACL, an individual is at greater risk for sustaining a future injury due to the lack of knee stability.
ACL Surgery
For those who do opt for surgery, there are several options for how to repair the ACL. However, ACL surgery is quite costly - ranging from $17000-25000 (http://pediatrics.aappublications.org/content/133/5/e1437 ).
The most common replacement, or "gold standard" for an ACL is to use the patellar tendon (above picture). This graft has a 90-95% success rate and allows the remaining patellar tendon to regrow following surgery. However, this graft produces the most pain following surgery and rehabilitation. |
Another option is to use a graft from the hamstring tendon (above picture). Because the quadriceps extension action is not affected, this graft choice usually results in less atrophy of the quadriceps muscle that is commonly seen as a part of the ACL recovery process. However, the initial recovery from a hamstring graft is quite slow due to the immobilization needed to heal the hamstring and knee.
Third, a quadriceps tendon graft can be used (lower left picture). The pain for this graft is intermediate to the patellar and hamstring graft options. The harvesting process is similar to that of the patellar tendon, but the vertical quadriceps tendon, which has a large cross-sectional area, is placed horizontally over the knee. This choice of graft does not create the same knee pain as occurs with the patellar graft. Finally, an allograft can be used, in which a tendon graft (patellar, hamstring, achilles, or quadriceps) is taken from a cadaver. This also results in less quadriceps atrophy as the quadriceps extension is not affected. In addition, there is no graft taken from the individual's own body, resulting in less pain in other areas and unaffected tendons. However, allografts do carry a risk for infection because the graft cannot be 100% sterilized before use without compromising the graft's strength. Infections such as hepatitis B and HIV can be transmitted, but chances are very small. While some doctors prefer to use allografts, most reserve them for ACL revisions or when there are multiple tears in the knee. In addition, there is a shortage of allografts, as well as a hefty price tag for using them. Allografts can cost $2000- 10000 depending on what tissue is used (http://www.orthoassociates.com/SP11B35/). |