The benefits and limitations of ACL repair compared to ACL reconstruction

The benefits and limitations of ACL repair compared to ACL reconstruction

London Cartilage Clinic

Written By London Cartilage Clinic

In the field of sports medicine and orthopaedics, the treatment of Anterior Cruciate Ligament (ACL) injuries continues to evolve, offering patients increasingly effective options. This is an important area of research as ACL injuries can prevent athletes from being physically active . ACL repair and ACL reconstruction are two distinct approaches, each with its own benefits and limitations. Understanding these can help patients make informed decisions about their treatment, focusing on preserving the natural integrity of their knee joint whenever possible. Find information on both approaches below.

Exploring ACL Repair and Reconstruction 

ACL Repair is a procedure aimed at mending the original ligament to restore its function. This approach is most effective when the ligament has detached from the bone and can be reattached without significant tension. At London Cartilage Clinic, this can be achieved using either the BEAR implant, BioBrace implant or STARR technique performed by one of our expert surgeons.

On the other hand, ACL Reconstruction involves replacing the damaged ligament with a graft. This is usually sourced from a tendon elsewhere in the patient’s body or from a donor. This method is often employed when the ligament is damaged beyond the possibility of repair. Reconstruction of the ACL is achieved typically through a keyhole (arthroscopic) procedure. This means that, instead of making larger incisions like a conventional surgery, the process is carried out through small holes in the skin around the knee. During the process, the surgeon will insert an arthroscope .

Benefits and Limitations of Each Method: 

ACL Repair: 

  • Benefits: Quicker recovery times as the original anatomy of the knee is preserved, including the ligament’s proprioceptive fibres. This can result in a more natural knee function post-recovery. The procedure is also minimally invasive and carries a lower risk of complication.
  • Limitations: Not suitable for all ACL injuries, particularly where the ligament is frayed or damaged mid-substance. The success rates can also vary depending on the exact nature of the injury. All these limitations will be discussed with you in person before you can be cleared for the surgery.

ACL Reconstruction: 

  • Benefits: Considered more reliable for complete tears or when the ligament is severely damaged. It provides long-term stability and is the standard treatment for athletes who wish to return to high-level sports. 
  • Limitations: The recovery can be lengthy, and there is a risk of complications related to the graft site. Additionally, using a tendon to replace a ligament may not fully replicate the original biomechanics of the knee. As such, patients may have to make lifestyle adjustments to return to the activities they are used to enjoying.

Clinical Perspectives and Decision Factors

The decision between ACL repair and reconstruction typically hinges on several factors including the type of tear, the patient’s age, activity level, and overall knee health. Advanced imaging and diagnostic tests can help surgeons recommend the most appropriate treatment, alongside one-on-one consultations. As discussed above, a major factor in the suitability of either surgery is the lifestyle of the individual. ACL reconstruction is generally better suited to those who are regularly active and wish to return to physical activities. Whereas ACL repair is intended for those who have suffered lesser injuries.


Expertise in ACL repair and reconstruction

Both ACL repair and reconstruction offer viable paths to recovery from knee injuries, with each method suited to different types of injuries and patient needs. London Cartilage Clinic offer these surgeries to allow our guests to return to their pre-injury life as soon as possible. By understanding the benefits and limitations of each methods, it’s our hope that patients can make choices that best suit their health and lifestyle goals. Our aim is to preserve the natural integrity of their knee through private surgical solutions such as ACL repair and ACL reconstruction. Contact us if you have any questions at all.

Frequently Asked Questions

Ideal candidates for ACL repair are those with proximal tears where the ligament has detached from the bone cleanly and the remaining ligament is of good quality. 

A2: While reconstruction is reliable, it changes the knee’s biomechanics slightly due to the use of a tendon instead of a ligament. Patients might notice a difference in sensation and movement, and there is a slight increase in the risk of osteoarthritis.

Surgeons consider the location and extent of the injury, the patient’s lifestyle, and their long-term activity goals. Younger, more active patients, especially those involved in pivoting sports, might benefit more from reconstruction.

Yes, if ACL repair fails, patients can still undergo ACL reconstruction. This flexibility allows patients to attempt repair with the possibility of conversion if necessary. 

Consider your recovery goals, the nature of your injury, and the potential risks and benefits of each procedure. Discussing these factors in depth with your orthopaedic surgeon will help guide your decision. 

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