The Anterior Cruciate Ligament is a very well studied piece of tissue. Over 100,000 ACL reconstructions are done annually in America, and overall the surgery is extremely successful. What do we know about what makes up the best methods for surgery and the outcomes?
There are multiple different types of autografts (a patient's own tissue) to use for ACL reconstruction. One is using a person's own bone-patella tendon graft or a hamstring tendon. Often times a person's hamstring graft is placed into a quadruple strand for greater strength. Studies looking at the differences in outcome between these 2 have not shown significant differences in most factors such as post-surgical knee laxity, ACL re-rupture rates, and functional outcome.
There are plenty of knee surgeons who utilize cadaver tissue (Allograft) for reconstructing the ACL. Is this less effective than using a person's own tissue? The studies have shown that it is pretty much equivalent. Failure rates for grafts range from 6 to 14%, with stability being the same. Patients improved functionally a lot with both types of grafts. Allografts have been shown to be successful for ACL reconstructions when compared with a person's own tissue (autograft).
When looking at specific outcomes functionally, studies overall have shown that between 60 and 80% of people are able to return completely to previous activity levels at 9 to 12 months after surgery. This is much less than 100% as most people think within 4 to 6 months.
Do patients develop arthritis after an ACL reconstruction? The answer appears to be yes in over half of patients. Studies have looked at patients in the age group between 15 and 22 ten years after surgery (then 25 to 32). A lot of patients have had to curtail their sports activities and really have seen a change in their knee quality of lives. People may think just because they get their ACL fixed that the risk of arthritis goes away. This is not true.
Patients who have an ACL reconstruction are definitely at risk of a re-rupture up to 20% of the time within 2 years. This may be due to either failure of the graft that was put in, or because of an athletic injury probably similar to how it happened the first time. Patients are also at risk of tearing the ACL in the opposite knee about 10% of the time.
The techniques for ACL reconstruction have improved dramatically over the past 2 decades, making the reconstructions much more anatomic. They are still not like what Mother Nature gave patients to begin with, but they are getting closer. The goal is to be as anatomic as possible, and the results have improved as the technique has gotten closer to it.
The overall answer is that functional outcomes have been dramatically improved over the past 20 years, with most patients having great outcomes. But there are limitations, and a significant chance of re-rupture along with a need for further surgery. It's not always like ESPN shows, where NFL players are back on the field within a year. Patients need to maintain realistic expectations.
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