Q: I am 29 and tore my ACL skiing. My orthopedic surgeon is recommending surgery. I went through physical therapy to get my thigh muscles strong and since I have done that my knee feels good. Do I have to have surgery and what are the possible complications if I do get it?

A: The anterior cruciate ligament is one of four major knee ligaments that maintains stability to the knee. It is important in many athletes for pivoting activities.

Not everyone who tears their ACL has to have surgery. After an ACL injury, a rehabilitation program is usually recommended to regain normal motion, decrease swelling and pain and regain strength of the quad and hamstring muscles. A recreational athlete or older individual who is not having instability complaints may be able to return to sports activities using a brace without significant risk of re-injury.

Reconstructive surgery is usually recommended for those who are young or want to regain a high level of athletic competition. Each time a knee buckles or ``gives way,'' there is an increased chance of additional damage to the meniscal and articular cartilage. This can result in significant arthritic risks with repeated injury. Also, surgery is usually recommended for non-athletes who have instability problems of the knee with their daily activities.

There are two methods of anterior cruciate ligament reconstruction -- using your own tissue in an ``autograft,'' or using specially prepared tissue from a cadaver in an ``allograft.''

Those who use their own tissue usually use the middle third of their kneecap tendon with a piece of bone from the kneecap and tibia, or two of their hamstring tendons.

The advantages of an autograft is there is no risk of disease transmission. But autograft surgery tends to be more painful than allograft, and there are increased risks of scarring, tendinitis of the patella (if the patellar tendon is used) and permanent weakness of the hamstrings and hamstring muscles (if hamstring tendons are used).

Allograft tissue is usually tested, cultured, frozen and, in many circumstances, irradiated. This is believed to decrease the risk of transmitting diseases such as HIV or hepatitis to about 1 in a million.

The advantages of allograft surgery include less pain, smaller scars and faster rehabilitation. Also, you are not theoretically weakening your own tissue.

Most studies have shown that, in terms of stability, long-term outcomes for autograft and allograft surgeries are equal.

I recommend that you have further discussion with your orthopedic surgeon to weigh the benefits and risks of each approach. If you are still unsure, you may want to consider a second orthopedic opinion.

The Jock Doc column runs every other week.

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