KNEE SURGERIES

ACL Repair

 

 

BONE-TENDON-BONE GRAFTS

Bone-tendon-bone grafts are made from part the knee cap, the patella tendon, and part of the tibia (shin bone). They are the most common graft use around the world and have the highest success rate. They are usually harvested from the same knee that the ACL is torn from at the time of reconstruction. They have the strongest fixation methods, the best healing rates, the lowest incidence of re-rupture, and produce the most stable knee over a lifetime. Because of these facts it is the graft most commonly used by Dr. Allison.

HAMSTRING GRAFTS

Hamstring grafts are made by taking the tendons of the hamstring muscles from the back of the leg in which the ACL is torn at the time of reconstruction. These have become more popular in the last few years with the advent of better fixation techniques. They have the advantage of not taking away any bone and may have less pain associate with them. They have the disadvantage of having a less stable knee due to the fact that the tendons may stretch over time, having a much higher re-rupture rate, and having a higher revision surgery rate. Two separate studies in the Journal of Sports Medicine have recommended that these grafts only be used on a limited bases on low activity patients. Because of these studies Dr. Allison is only using these grafts on very selective patients.

ALLOGRAFT GRAFTS

An allograft is a graft that is taken from a cadaver (a person who is no longer living). These can be bone-tendon-bone grafts, hamstring grafts, or even from part of the heel and a part of the Achilles tendon. Although they are extensively tested there is still a small chance that disease could be spread through these grafts. Their healing rates are lower and there is a higher re-rupture rate and re-operation. Dr. Allison only uses these grafts on patients who have had multiple surgeries and have no other alternative.

ARTIFICIAL GRAFTS

Some artificial materials have been used to try to reconstruct the ACL without taking a graft from the patient or placing a graft from another person. The most widely used of these was the Dacron graft. These artificial grafts caused a reaction within the knee and had to be abandoned. There are currently no artificial grafts that work well or considered reasonable for ACL reconstruction at this time.

REPAIR WITHOUT A GRAFT

When ACL surgery first began, the knee would simply be opened and the ACL sutured back together. It was found that the ACL would not heal and the sutures would finally pull through. These knees would have to go through a revision surgery to reconstruct the ACL using a graft. Direct repair of the ACL by suturing is not considered a standard of care at this time.

 
ACL Repair

Dr. Allison selects grafts based on patients size, level of activity, bone quality, and whether they have had a previous knee surgery or not.

 

 

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