Your Age Helps Docs Find Best Option for ACL Repair

Research supports use of particular type of graft

Knee replacement bandage

Contributor: Kurt Spindler, MD

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Have you torn your anterior cruciate ligament (ACL)? If, unfortunately, you have, and you’re considering surgical reconstruction, you and your doctor need to weigh one factor very carefully when you discuss treatment options: your age. Recent research shows that the patient’s age and the type of graft performed can predict the chance of success or failure of a first-time ACL repair.

When to consider surgery

When it’s working correctly, the ACL helps stabilize the knee and protects it from shifting or rotating out of place. It connects the femur (thigh) and tibia (shin) bones.  

Most ACL injuries are complete tears, where the ligament splits in two, making the knee unstable.

Not all tears require surgery. These injuries usually result from a sudden stop or change in direction, landing incorrectly or direct contact, such as a collision.

Your doctor may recommend surgery if:

  • Your knee has more than just ACL damage
  • The injury causes pain or affects everyday activities
  • You are young and active
  • You are an athlete and want to continue playing your sport

ACL tears cannot be stitched back together. Rather, surgeons replace the ligament with one of two types of tissue grafts. An autograft comes from your own body, usually a tendon from the kneecap or hamstrings. An allograft involves a tendon taken from a deceased donor.

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Both graft sources have advantages and disadvantages that you should thoroughly discuss with your surgeon.

New research about age and ACL repair

The initial reconstruction of a torn ACL is likely to have a positive outcome. But if that reconstruction fails (meaning the ligament is reinjured or ruptured within two years), the outlook for a second surgery is not as good.

Recent research shows that the patient’s age and the type of graft performed can predict the chance of success or failure of a first-time ACL repair.

Those studies indicate that younger, more active patients are less likely to have their ACL reconstruction fail when an autograft is used rather than an allograft.

As a patient’s age increases, however, so does the chance of success with an allograft. Researchers aren’t sure why. By age 40, there is almost no absolute difference (less than 2 percent) in the failure rate of an allograft versus an autograft.

If you are facing ACL reconstruction, it’s important to ask your doctor about the risk of failure in someone of your age and activity level.

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What to expect after ACL reconstruction

After surgery, rehabilitation plays a vital role in restoring knee strength, stability and motion. Physical therapy may be long and rigorous and involves:

  • Restoring motion to the joint and muscles
  • Strengthening the knee to protect the new ligament
  • Returning the function you need for your sport or work

You also will learn preventive measures to lessen the chances of re-injury. These may include proper warm-up, how to land correctly from a jump, and strength training to build your muscles.

If ACL surgery is in your future, carefully review the risks, benefits and rehab needed with your physician. Based on the research, your age and activity level should be part of that discussion.

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