ACL Repair vs. ACL Reconstruction: What’s the Difference and Which Is Right for You?

Anterior cruciate ligament (ACL) injuries are among the most common and devastating injuries in sports, often requiring surgical intervention to restore knee stability and function. When an ACL is torn, patients typically face two primary surgical options: ACL repair and ACL reconstruction. While both procedures aim to restore knee function and allow patients to return to their active lifestyles, they are fundamentally different in terms of technique, recovery, and long-term outcomes. Understanding the differences between ACL repair and ACL reconstruction can help patients make informed decisions about their treatment options.

1. What Is ACL Repair?

Technique: ACL repair involves reattaching the torn ends of the original ligament to the bone. This procedure is only possible if the tear occurs in a location where the ligament can be reattached, such as at the ligament’s insertion point on the bone. During ACL repair, the surgeon uses sutures, anchors, or other fixation devices to reattach the torn ligament and secure it in place.

Ideal Candidates:

• Proximal Tears: ACL repair is generally most successful in cases where the ligament tears near its attachment point on the bone (proximal tears). In these cases, there may be enough healthy tissue to allow for successful reattachment.
• Acute Injuries: ACL repair is typically performed soon after the injury occurs, as the ligament’s ability to heal decreases over time.
• Younger Patients: Younger patients with good tissue quality may have better outcomes with ACL repair.

Advantages:

• Preservation of Native Tissue: ACL repair preserves the patient’s original ligament, which may lead to a more natural feeling knee post-surgery.
• Shorter Recovery Time: In some cases, ACL repair may result in a shorter recovery time compared to ACL reconstruction, allowing patients to return to their activities sooner.
• Less Invasive: ACL repair is generally less invasive than reconstruction, as it does not require the harvesting of a graft from another part of the body.

Disadvantages:

• Higher Risk of Retear: ACL repair has been associated with a higher risk of retear compared to ACL reconstruction, particularly in active patients. The repaired ligament may not be as strong as a reconstructed ligament.
• Limited Candidates: Not all patients are candidates for ACL repair, particularly if the tear is not located near the bone or if the ligament is severely damaged.

2. What Is ACL Reconstruction?

Technique: ACL reconstruction involves replacing the torn ligament with a graft, which can be harvested from the patient’s own body (autograft) or from a donor (allograft). Common graft options include the patellar tendon, hamstring tendon, or quadriceps tendon. During the procedure, the surgeon creates tunnels in the bone to pass the graft through and secure it in place, effectively creating a new ligament that can perform the functions of the original ACL.

Ideal Candidates:

• Complete Tears: ACL reconstruction is the standard of care for patients with complete ACL tears, particularly when the ligament is damaged beyond repair.
• Active Individuals: Athletes and active individuals are often better candidates for ACL reconstruction due to the durability of the reconstructed ligament.
• Chronic Instability: Patients who experience ongoing knee instability following an ACL injury may require reconstruction to restore knee function.

Advantages:

• Proven Track Record: ACL reconstruction has a long history of success, with the majority of patients returning to their previous levels of activity.
• Lower Retear Rate: Compared to ACL repair, reconstruction generally has a lower risk of retear, particularly when performed with proper surgical technique and followed by a comprehensive rehabilitation program.
• Customizable Grafts: Surgeons can choose the best graft option for each patient, tailoring the procedure to individual needs and ensuring a strong, stable knee.

Disadvantages:

• Longer Recovery Time: ACL reconstruction typically involves a longer recovery period, often 6 to 12 months, as the new ligament graft needs time to integrate with the bone and regain strength.
• Graft Harvesting: If an autograft is used, the harvesting process can create additional surgical sites, which may cause discomfort or complications in the donor area.
• Invasive Procedure: ACL reconstruction is more invasive than repair, requiring bone tunnels and the replacement of the entire ligament.

3. Choosing Between ACL Repair and ACL Reconstruction

The decision between ACL repair and ACL reconstruction depends on several factors, including the nature of the injury, the patient’s activity level, and the goals for recovery.

• Type of Tear: If the ACL tear is proximal and there is sufficient healthy tissue, ACL repair may be a viable option. However, for complete or mid-substance tears, ACL reconstruction is typically recommended.

• Patient Age and Activity Level: Younger, active patients may benefit more from ACL reconstruction due to the lower risk of retear and the durability of the reconstructed ligament. In contrast, older patients or those with lower activity levels might consider ACL repair if they are candidates.

• Surgeon’s Expertise: The surgeon’s experience and comfort with either procedure can also play a role in the decision-making process. Some surgeons may prefer reconstruction due to its proven success rates, while others may offer repair as an option for select patients.

• Long-Term Goals: Patients should consider their long-term goals when choosing a procedure. Those looking to return to high-level sports or physically demanding activities may opt for reconstruction, while those with less demanding goals might consider repair.

4. The Future of ACL Surgery: Emerging Techniques

The field of ACL surgery is continuously evolving, with new techniques and technologies being developed to improve outcomes for patients. For example, some surgeons are exploring the use of biological augmentation, such as platelet-rich plasma (PRP) or stem cells, to enhance the healing process in both ACL repair and reconstruction. Additionally, improvements in surgical techniques and rehabilitation protocols continue to reduce recovery times and improve long-term knee function.

Conclusion

Both ACL repair and ACL reconstruction offer pathways to recovery after an ACL injury, but they are distinctly different procedures with unique advantages and challenges. ACL repair may be an option for select patients with specific types of tears and offers a potentially quicker recovery. However, ACL reconstruction remains the gold standard for most ACL injuries, particularly for active individuals and those with complete tears.

Choosing the right procedure involves careful consideration of the injury’s specifics, the patient’s lifestyle, and the surgeon’s expertise. By understanding the differences between ACL repair and ACL reconstruction, patients can make informed decisions that align with their long-term health and activity goals.

At Princeton Sports and Family Medicine, P.C., our doctors specialize in sports medicine services, including exercise counseling and physician services to assess your risk for injury and assist in your performance goals.

Call or click to book a session with our professionals at Princeton Sports and Family Medicine, P.C. In addition to problem-focused visits, we offer sports performance evaluations to stop problems before they start. Plan your visit today!

Author

Peter Wenger, MD Peter C. Wenger, MD, is an orthopedic and non-operative sports injury specialist at Princeton Sports and Family Medicine, P.C., in Lawrenceville, New Jersey. He is board certified in both family medicine and sports medicine. Dr. Wenger brings a unique approach to sports medicine care with his comprehensive understanding of family medicine, sports medicine, and surgery. As a multisport athlete himself, he understands a patient’s desire to safely return to their sport.