This is Dr. Kevin Stone talking about our current thoughts about reconstructing the anterior cruciate ligament in athletic people who rupture their knee joint ligaments. The anterior cruciate ligament is the key guidewire in the middle of the knee that stabilizes the knee and is often injured in skiing, soccer, football, basketball, and twisting sports. We recognized that when people rupture their cruciate ligament some people will heal it on their own, some people will not need it to be repaired or reconstructed, but most athletic people will develop an unstable knee after rupture of the cruciate ligament and require reconstruction if they want to have a stable, sports active knee. Injuries to the anterior cruciate ligament are often accompanied by other injuries around the knee such as tears in the meniscus cartilage or damage to the articular cartilage, the covering of the joint. We think it is extremely important to make a very accurate, early diagnosis after a knee joint ligament injury and we use a physical examination, x-rays, a careful history, and a high quality magnetic resonance image to study both the ligament and the associated damage to the knee joint. After the initial injury calms down we then plan for a reconstruction of the cruciate ligament if required. Occasionally, we are able to primarily repair the ligament when it is torn high in on the knee into the bone. A repair technique is discussed in a separate podcast.

Our ACL reconstruction technique involves the following points. First, our graft selection. In the past, we almost always used the patient’s own bone patellar tendon bone from the front of their knee to reconstruct their torn anterior cruciate ligament when it was not repairable. Over the last few years, however, we have been able to obtain sterilized human cadaver, or donor, bone patellar tendon bone grafts. These grafts have proven in our hands to be as strong as the patient’s own patellar tendon bone and lead to an equally excellent outcome when reconstructing the knee. Therefore, we have switched our bias to most of the time using a donor bone patellar bone graft to reconstruct the ruptured anterior cruciate ligament. Our preference is to do this surgical procedure through a two incision technique using interference fit screws for fixation, which permit us to allow the patient an early range of motion rehabilitation program. Surgical accuracy is crucial to obtaining an excellent result and a careful rehabilitation program that is designed to go with the surgery often helps create that excellent result for many people who suffer a ruptured cruciate ligament. Our belief is that ruptured cruciate ligaments can be reconstructured and repaired and they can permit the patient to return to full sports as long as the surgery and rehabilitation are designed to go together and conducted effectively. The time frame to return to sports after and ACL reconstruction depends quite a bit on the patient and the surgical procedure performed. Assuming that the surgical procedure is performed perfectly and the patient does an excellent rehabilitation program returning their strength and full motion within a couple of months than they are able to return to most sports. The ligament strength does not come back to full strength until 12 – 18 months after reconstruction. However, the strength seems to be good enough in the first year to permit most sports as the re-rupture, or laxity rate, in the first year seems to be quite low. The success rates of reconstruction of anterior cruciate ligaments in our hands with our technique is over 90% return to a stable knee with a full range of motion and full sports.

Future research on the anterior cruciate ligament is extremely exciting. At The Stone Clinic we have been investigating the use of pig tissue to replace the anterior cruciate ligament and this research has led to an FDA approval for a wide clinical trial of a new pig ligament that may, in the future, augment or replace the use of human tissue. Additional studies are underway using both stem cells and growth factors to augment the healing time. Lastly, our rehabilitation programs are continually evolving in order to optimize early full range of motion and be able to optimize early maturation of the tissues in order to return to full sports. For more information about these surgical techniques we have posted the techniques and rehabilitation programs at www.StoneClinc.com.

Thank you very much.

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The Stone Clinic in San Francisco concentrates on returning injured people to their active lives, fitter, faster, and stronger than they were before. The Stone Clinic includes Dr. Kevin Stone, physician and surgeon, a staff of physical therapists, and an x-ray and MRI facility. Our specialties include the treatment of joint injuries and arthritis with leading edge surgical and rehabilitation techniques. Elite athletes and everyday people alike come to The Stone Clinic from around the world for the best in orthopaedic care. The Stone Clinic is located at 3727 Buchanan St., San Francisco, CA 94123. For more information, please call us at (415) 563-3110 or visit us at www.stoneclinic.com.