Three letters dreaded by most athletes: A.C.L. which stands for anterior cruciate ligament is a common knee injury where a tear or sprain occurs when a sudden change in direction or pivot occurs on a locked knee. The ACL is what keeps your shinbone, or tibia, from sliding forward under the thighbone (femur) and stabilizes the knee from rotating. Without this ligament the knee becomes unstable and can buckle. When the tear occurs, patients usually describe a loud pop and then very intense knee pain especially when walking or weight-bearing, followed by swelling of the joint. There are two treatment approaches: surgically and non-surgically, which typically depends on the level of activity there was before injury.
If a surgical approach is taken, surgeons may use two different types of grafts to reconstruct the ligament: an autograft or an allograft. An autograft is tissue from the patient’s own knee such as the hamstring tendon or the patella tendon. An allograft is tissue from a cadaver to create a new ligament. There are pro’s and con’s to using either approach, both have had excellent clinical results but both have their disadvantages.
Using an autograph from either the patella or hamstring produce very strong grafts, however there is typically more post-surgical pain and possible joint stiffness. Numbness may occur in the front of the knee with the patellar grafts, and there may be hamstring weakness when using the hamstring graft. Allografts, on the other hand, are the least painful post-operatively, have no risks from the donor site, and allow for faster return to activities of daily living. The disadvantages though, involve risk of infection of HIV from donor graft, or viral/bacterial infection during the surgical process. It should also be noted that although there is typically little pain involved, the new ligament needs time to heal and caution should be taken to not rip the graft by progressing too quickly to active exercises. Full return to athletic activities for either grafts are typically 6-7 months. Make sure to ask your doctor about both options and which one would be more beneficial for you.