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ACL Tears

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)
ACL reconstruction involves replacing the torn ligament with a graft, typically using tissue from:
  • Quadriceps tendon (most common)
  • Patellar tendon
  • Hamstring tendon
This procedure requires drilling sockets in the bone to secure the graft and create a new ACL.
      
Benefits of ACL Reconstruction:
  • Gold standard and most commonly performed procedure
  • High success rate in restoring knee stability
Recovery Time: Approximately 9-12 months to return to sports or high-level activities.

ACL Reconstruction Post-Op Instructions CLICK HERE

2. ACL Repair (If Possible)
In some cases, particularly when the tear is located near the ligament’s attachment to the bone (rather than in the middle), it may be possible to repair the native ligament. This involves using sutures and small anchors to reattach the torn ligament to the bone.
    
Benefits of ACL Repair:
  • 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
Important Considerations for ACL Repair:
  • 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.

3. Lateral Extra-articular Tenodesis (LET)
In some cases, Dr. Jazayeri may recommend an additional procedure called Lateral Extra-articular Tenodesis (LET), also known as a modified Lemaire’s procedure. This involves using a portion of the iliotibial band (ITB) to provide additional support to the ACL repair or reconstruction. LET acts as a "seat belt" for the ACL, offering enhanced stability.
Who Benefits from LET?
  • High-level athletes
  • Patients at high risk for retears (e.g., young athletes, individuals involved in contact sports)
Procedure Details:
  • 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.
*Dr. Jazayeri generally recommends LET for high-risk patients who desire to return to high-level cutting sports.





What Happens Next? Dr. Jazayeri will recommend the procedure that is safest and most effective for you. Whether you have a repair or a reconstruction, our goal is to restore your knee’s function and get you back to the activities you enjoy. Rehabilitation and physical therapy are critical parts of your recovery, regardless of the procedure.

Key Takeaway: ACL reconstruction remains the gold standard and is performed in the majority of cases. However, ACL repair is an excellent option for specific tear patterns, offering several advantages, including faster recovery and less postoperative discomfort, when it is possible. For high-risk patients, the addition of LET can provide further stability and minimize the risk of retears. Ultimately, the surgical approach will be tailored to your individual needs.
   



If you have questions or concerns, please don’t hesitate to ask Dr. Jazayeri or the care team:  (855) 892-0919