What is an ACL Tear? 

The anterior cruciate ligament (ACL) is a key structure in your knee that helps stabilize it during movement. An ACL tear occurs when this ligament is stretched beyond its limits, often during activities like sports, sudden stops, or twists. ACL injuries can vary in severity, from partial tears to complete ruptures. Without treatment, an ACL tear can lead to instability, difficulty with physical activities, and an increased risk of further knee damage.

Treatment Options 

When treating an ACL tear, the two main surgical options are ACL repair and ACL reconstruction. The best option for you depends on the location and pattern of the tear, as well as the quality of the torn ligament tissue.    

1. ACL Reconstruction (Gold Standard)

• Quadriceps tendon
• Patellar tendon
• Hamstring tendon

Choosing the Best Graft: 

ACL reconstruction surgery involves using a graft to create or reconstruct a new ACL (Anterior Cruciate Ligament). This graft is typically taken from the patient (autograft) and is the gold standard of care for patients under age 35. For patients above age 35, an allograft or tissue using a cadaver is an option. 

Autografts have been shown to have a significantly lower retear rate compared to allografts/cadaver tissue in younger, more athletic patients and are strongly recommended for all athletes and any patient under age 35. After age 35 both grafts (autograft or allografts) have comparable results. Autograft options include harvesting or taking a portion of the patient’s own (quadriceps tendon, patellar tendon or hamstrings tendons). 

Dr. Jazayeri’s graft of choice is the quadriceps tendon autograft. This technique involves using approximately a 1cm x 7cm portion of the operative leg’s quadriceps tendon to create the new ACL. This means you will have an incision over the front of your quadriceps muscle in order to harvest the graft. After the graft is taken, the incision will be closed, and the remainder of the surgery will be performed arthroscopically through a minimally invasive all-inside technique.      

• Gold standard and most commonly performed procedure
• High success rate in restoring knee stability

ACL Reconstruction Post-Op Instructions CLICK HERE

2. ACL Repair (If Possible)

• Maintains your natural/native ligament
• No need for graft harvesting (avoiding additional incisions and donor site pain)
• No drilling of sockets in the bone
• Faster recovery: approximately 6 months
• Less postoperative pain

• Repair is not always possible: The quality of the torn ligament tissue and the specific tear pattern will determine if repair is an option. Tears located at the end of the ligament near the bone are more likely to be repairable, while mid-substance tears typically require reconstruction.
• Timing Factor: ACL repairs are generally most successful when performed soon after the tear (acute), as they have a better chance for healing. Most chronic ACL tears (greater than 3 months old) become more difficult to repair and have less reliable healing.
• Intraoperative Decision: During surgery, Dr. Jazayeri will assess the tear pattern and tissue quality to decide whether repair is feasible. You will be consented for both repair and reconstruction before surgery to prepare for either outcome.
• Risk of Failure: If a repair does not heal adequately, a second surgery for reconstruction may be needed. Patients considering repair should understand and be prepared for this possibility.

• High-level athletes
• Patients at high risk for retears (e.g., young athletes, individuals involved in contact sports)

• A small, additional incision (approximately 7 cm) is made on the side of the knee.
• A portion of the ITB is used to reinforce the knee’s stability.
• LET does not extend the recovery time and is highly effective in minimizing the risk of ACL retears.