Q. I am 19 and tore my ACL playing soccer. I want to remain active and keep playing sports. The doctor said I would need surgery to reconstruct a new ACL.
He gave me a choice of using my own kneecap tendon or hamstring tendons to make the new ligament or said I could use a graft from a cadaver to make a ligament. I was hoping that the surgeon could just fix the ACL; however, since that is not an option, what would be my best graft choice?
A: The anterior cruciate ligament (ACL) is a ligament in the knee that is important for stability in pivoting or twisting activities.
If the ACL is torn, it does not have an adequate blood supply to heal, thus it cannot be fixed. The advantage of using your own middle third of the kneecap tendon for a graft is that it is strong and usually works well. The downside is that it can be a more painful procedure that can also lead to kneecap arthritis in about 10 years.
Using two of your own hamstring tendons also works well, but in some patients permanent hamstring muscle weakness and cramping persist.
Using a cadaver patellar tendon graft has the advantage of being minimally invasive and not weakening your tendons. The downside is a one-in-a-million chance of disease transmission and a mildly greater risk of re-tear.
Generally, all of these graft choices work well if the graft is properly positioned by a skilled orthopedic surgeon. The post-op rehab program is also a key to surgical success.
Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to HarlanS@baptisthealth.net.