ACL Repair vs Reconstruction: What’s The Difference Between Surgical Options?

Damaging The Critical ACL Ligament

ACL tears are a common yet painful knee injury. Close to 150,000 ACL injuries happen each year, mainly in sports. The ACL or anterior cruciate ligament is 1 of 4 vital ligaments that hold the knee together. These ligaments help with the rotation and back-and-forth motion of the knee. If the ACL tears, medical help is critical to restoring movement.

Symptoms and choices

ACL tears cause knee instability, making movement difficult. People with ACL tears also experience severe pain and swelling. An orthopedic surgeon will review the damaged ligament using an MRI. From there, the patient will need surgery. There is a lot of confusion surrounding which type of procedure works best. Does the patient need an ACL repair or ACL reconstruction? The type of surgery often depends on the degree of injury.

More than a quick fix

An ACL repair is a minimally invasive procedure to reattach the torn ligament. This process consists of small incisions and a scope to view and fix the injury. The surgeon then attaches the torn ligament to the bone using stitches. Surgeons rarely perform ACL repair. Often, there is no blood supply for the ligament to heal. However, ACL repair has gained traction in the last 30 years as an alternative to reconstruction. That's because technology has allowed surgeons to develop techniques like BEAR surgery.

A brand new ligament

An orthopedic surgeon will often opt for ACL reconstruction. ACL reconstruction is an arthroscopic procedure as well. The surgeon replaces the damaged part with a new tendon. The replacement ligament comes from another part of the body or a donor. Using small incisions, the surgeon inserts the scope for a clear view of the knee. The surgeon then removes the damaged ligament, cleaning the surrounding area. Additional small cuts give the surgeon access to insert and anchor the new ligament to the surrounding bone.

The advantages of surgery

Both styles have the advantage of being minimally invasive. The procedures are faster, with shorter recovery time. Both methods also require physical therapy. While there are some non-surgical treatment options, surgery gets the most active patients walking and pain-free in short order.

So what's the difference?

Of course, the most significant difference lies in philosophy. One depends on a brand new, collagen-rich replacement. The other trusts that the body can repair the damaged ligament once repaired. Repair also has the advantage of shorter recovery time compared to rebuilding. At the same time, ACL repairs only work in specific circumstances. A good example is if the ACL tore cleanly off the bone and is still intact. The difference comes down to the needs of the patient, degree of damage, and surgeon expertise.

Is there a better choice?

In the realm of orthopedic surgery, repair versus reconstruction is a hotly contested topic. Many surgeons and scientists believe that repair does not work long-term as the ligament lacks blood flow. Some research backs up this concern. For example, over time, repaired ACLs can cause damage to other critical areas like the meniscus. However, other studies see no difference in success rates. Even recently, a clinical study of BEAR ACL repair showed the same results as reconstruction. ACL reconstruction is proven while there are still mixed reviews on a repair.

A better knee, a better life

ACL tears can be distressing. However, the right surgical procedure can get patients walking again. In most cases, ACL reconstruction has long-term benefits. However, there may be some cases where ACL repair will be successful, with shorter recovery. The best bet is to seek help from an orthopedic surgeon who understands both procedures. The surgeon will give sound advice based on factors like age, health, and degree of tear.