From an interview with
Dr. Zachary DiPaolo
McLeod Orthopaedics Florence
A knee’s torn Anterior Cruciate Ligament usually can’t be stitched back together. To rebuild the shredded ligament takes a lot more but there are numerous options according to McLeod Orthopedic Surgeon Dr. Zachary DiPaolo.
Here’s a summary of Dr. Dipaolo’s comments:
When we talk about fixing an ACL tear, a lot of patients just say, “Oh, it’s going to be an ACL repair. I’m going to show up. They’re going to fix it. We’re going to go on.” They think about it like a fracture, where we’re actually fixing a bone.
The problem with the ACL is that it’s inside the knee and does not have a good capacity to heal by just reattaching. The torn ends are more like ruptures — almost like a bomb went off, completely shredding the end of the ligament. There’s really nothing usable to sew back together. So, frequently we perform an ACL reconstruction.
Patients with an ACL tear should plan on a minimum nine-month recovery before they can return to sports participation. The biology of an ACL reconstruction healing simply takes at least nine to 12 months, if not longer. Many doctors believe it should be even longer — in the range of 12-18 months — before the return to pivoting or cutting sports. Scientific data shows that if you go back too soon, especially before six months, there’sa significantly increased risk of re-rupturing the ACL.
Not every ACL that tears needs surgery. There are a subset of patients that we call coper’s, where we actually send them to physical therapy for strengthening and rehab. They get a stable knee and can even go back to doing some sports. The problem is that 1) most people don’t want to cope and 2) it’s difficult to rehab an ACL. One main reason to reconstruct the ACL is that without the ACL you do have some low-grade knee instability. If a person returns to sports without a reconstruction, that low-grade knee instability becomes very problematic. Every time your knee buckles and twists, you increase the risk of tearing the meniscus or furthering the articular cartilage damage. So, the main reason we reconstruct the ACL is to protect the rest of the knee for the long term.