ACL Reconstruction and Meniscus Repair: Key Insights

Anterior cruciate ligament reconstruction and meniscus repair?

Hello Doctor,
On August 20, I underwent anterior cruciate ligament (ACL) reconstruction using hamstring tendons and repair of a root tear in the meniscus.
Three days ago, I had a follow-up appointment with my attending physician, who carefully explained the entire procedure to me.
The doctor mentioned that I had an "anatomical" ACL reconstruction.
In recent years, there has been a trend to choose isometric points for treatment, but my doctor opted for a point closer to the isometric location for the surgery.
He also showed me intraoperative photos and pointed out a small segment that was my original ACL.
At the time, I didn't think much of it, but after returning home, I read and watched many videos and academic reports on ACL reconstruction.
I found that generally, the remaining part of the ACL is removed before reconstruction.
So, is it possible that I misunderstood? Or is it indeed the case that some surgeons retain the original ACL during surgery? Of course, the articles I read also mentioned that if the remaining ACL is connected, there is a 50% chance of re-injury occurring easily.
To summarize my questions:
1.
What is "anatomical" ACL reconstruction?
2.
Is there an advantage to choosing a non-isometric point for tunneling?
3.
Most importantly, is it possible that my old ACL is still intact? They said it was an ACL reconstruction using hamstring tendons, so it doesn't make sense for my old ACL to still be there, right? Or is it indeed possible?
My attending physician is currently abroad, so I cannot directly ask him.
I hope you can help clarify my confusion so that I can eat and sleep better.
Thank you!

Da Qiu Shou Shang, 20~29 year old female. Ask Date: 2015/09/04

Dr. Shi Guozheng reply Orthopedics

You have already completed the surgery, so you should consult your attending physician.
Regardless of the method used, the goal is to achieve a successful surgery.
The old anterior cruciate ligament (ACL) is usually torn or ruptured after an injury, leading to poor function, which necessitates reconstruction surgery.
Simply reconnecting it often yields unsatisfactory results.
The tendon used in your surgery is appropriate and is commonly employed by physicians; this is the standard practice in clinical settings.
There are also other methods available.
It is important to engage in rehabilitation, which may take three to six months for function to potentially recover to a certain level.

Reply Date: 2015/09/04

More Info

Understanding ACL (anterior cruciate ligament) reconstruction and meniscus repair is crucial for patients undergoing these procedures, especially when there are concerns about the surgical techniques and outcomes. Here’s a comprehensive overview addressing your questions and providing insights into the surgical process.

1. What is "Deconstructed" ACL Reconstruction?
"Deconstructed" ACL reconstruction refers to a surgical technique where the remaining fibers of the ACL are preserved during the reconstruction process. Traditionally, in ACL reconstruction, the damaged ligament is completely removed, and a graft (often from the hamstring tendons or patellar tendon) is used to replace it. However, in some modern techniques, surgeons may choose to leave a portion of the original ACL intact, especially if it is not severely damaged. This approach aims to maintain some of the native ligament's structural integrity and potentially enhance the healing process and proprioception (the body’s ability to sense movement and position).

2. Is There an Advantage to Choosing a Non-Isometric Point for Tunneling?
The choice of the tunnel location during ACL reconstruction is critical for the stability and function of the new ligament. Isometric points are areas where the graft length remains relatively constant during knee movement, which can help in maintaining tension and stability. However, some surgeons, like yours, may opt for a location closer to the non-isometric point based on individual anatomical considerations or specific surgical goals.
Using a non-isometric point may allow for better graft fixation and alignment with the knee's natural biomechanics, but it can also lead to changes in tension during knee flexion and extension. The decision ultimately depends on the surgeon's assessment of the knee's anatomy and the specific injury characteristics.

3. Is It Possible for the Old ACL to Still Be Present?
In your case, if your surgeon mentioned that a portion of your original ACL was preserved, it is indeed possible. Some surgeons are now adopting techniques that allow for the preservation of the native ACL fibers, especially if they are not completely torn. This approach can potentially reduce the risk of re-injury and improve the overall function of the knee post-surgery.
However, if the ACL was significantly damaged or if the root tear of the meniscus was involved, it is more common to remove the damaged ligament entirely. The presence of the original ACL fibers does not negate the need for reconstruction; rather, it may enhance the overall stability and function of the knee.

Conclusion
It’s understandable to have concerns and questions following such a significant surgical procedure. The preservation of the original ACL fibers, the choice of tunnel placement, and the overall technique used can all influence your recovery and the long-term success of the surgery.
If you have lingering doubts or concerns about your recovery, it may be beneficial to seek a second opinion from another orthopedic specialist or wait until your primary surgeon returns to clarify these points. Remember, your recovery process is important, and understanding your surgery can help alleviate anxiety and improve your overall well-being.
In the meantime, focus on your rehabilitation exercises as prescribed, and ensure you are following up with your healthcare provider for any post-operative concerns. Proper rehabilitation is key to a successful recovery from ACL reconstruction and meniscus repair.

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