Brevard Orthopaedics

Athroscopic Anterior Cruciate Ligament Reconstruction of the Knee

One of a few things in life that never gets old for John Bradford is jumping out of planes. Now most people would not say that jumping from a perfectly good plane gives them a since of freedom, but for John it does and that's why he has jumped over 500 times. His skydiving has introduced him to lots of people and places including the often-photographed group formation jumps that are technically difficult and highly dangerous, if just jumping out of a plane at 10,000+ feet is not dangerous enough. One of the people that John met as a result of his hobby is Dr. Graham. John knew through his experience that one needs to have dependable and pain free knees to jump out of planes and land safely. The stresses on the knee during a landing can be multiples of 10x's your body weight and if the knee is not stable that can lead to a hazardous landing risking additional bodily injury or injury to one of your other skydiving partners. John came to Dr. Graham several years ago because he was having problems with his knee after an injury. He was diagnosed with an anterior cruciate ligament (ACL) tear by Dr. Graham in the clinic and this was confirmed by MRI scan. Though some people due to their lack of activity or advancing age may not need an ACL reconstruction Dr. Graham and John came to a decision that if he wanted to continue to skydive that it would be best to have his ACL reconstructed.

An ACL reconstruction can be done in various ways. Some are done as an outpatient, but often people stay overnight stay in the hospital. The surgery takes approximately 1.5 to 3 hours depending on all that needs to be done at the time of surgery. Frequently people with an ACL tear may also have meniscal or articular cartilage injuries that also require attention at the time of surgery. The goal of the surgery is to restore stability to the knee to allow one to continue to participate in sports and other physical activities that require a stable knee. The ACL ligament cannot be felt or touched from the outside of the knee. It is located centrally in the knee and provides what orthopaedic surgeons call ' Rotatory Stability ' of the knee allowing one to jump, run and change directions quickly without the knee shifting abnormally. People that have experienced the instability that occurs as a result of a torn ACL often describe it as a buckling sensation or an insecurity that is felt when they are playing a sport that requires sudden changes in direction such as tennis, snow skiing, football and soccer, to name a few. Golfers, bikers, and runners (if they are not too aggressive) may be able to get by without their ACL, but often these sports as well need to be given up if the knee is too unstable.

One of the choices that patients have when they are going to undergo ACL reconstruction is whether to use their own tissue as the new ACL, which entails borrowing a portion of a ligament or tendon that is located nearby through a small incision, or using a donated tendon from a tissue bank. The later option is often chosen, because it cuts a several minutes off the surgical time and is more convenient for the patient as well as the surgeon, but this choice is much more expensive than using the patient's own ligament and does carry with it some risk such as unusual and potentially serious infections. A recent study presented at the 2007 AAOS in San Diego reported a significant cost differential with little clinical advantage of using a tissue bank graft.

After a detailed discussion on all the surgical options John decided with Dr. Graham to have his ACL reconstruction done using one of his own ligaments. The surgery was done arthroscopically which allowed Dr. Graham to place the location of the ligament as precisely as possible so that the new ACL would mimic John's ACL before it was torn. The surgery first calls for removal of all of the original ACL's damaged fibers and a general inspection of the entire joint. Then two bone tunnels are made, one in the distal thigh bone (femur), and the other in the proximal leg bone (tibia). The new ligament is then pulled through these tunnels so that it spans the joint space recreating the course that the John's damage ACL had taken prior to being torn. Each end of the new ligament was then secured so that it would stay taunt inside the tunnel until healing was complete.

For the first few weeks after the ACL reconstruction John was diligent in doing his post-operative exercise routine given to him by the physical therapist at the hospital. A big portion of the success of the surgery depended on John's determination to stick with this exercise routine so that his knee would not stiffen and his muscles would not weaken excessively. John did these exercises faithfully. Once the knee had recovered from the immediate pain and swelling that accompanies any surgery Dr. Graham prescribed a formal physical therapy program that would carry John and his newly repaired knee to a full recovery. This Physical Therapy program is designed with the specific goal in mind to allow one to return to their chosen sport or activity and John knew he wanted to skydive again. The therapy routine is a highly structured training and strengthening program that incorporates balance and agility over a period of 6 months after the surgery. It takes that long for the new ligament to mature and the muscles to be retrained. John also knew that the hard work of retraining his knee would be hard, but well worth the effort long term. Dr.Graham was impressed with the effort John put into his knee, but wasn't sure John would have the confidence to jump once again. Once John completed the Physical Therapy program Dr Graham discussed with John the importance of continuing his strength and agility program on his own and told John that it would then be up to him if he wanted to return to jumping out of planes. Much to Dr. Graham's surprise John did return to that sense of freedom that only comes from soaring in the heavens above the earth thousands of feet below. Dr. Graham is proud to say that he was able to give John back a strong and stable knee. John has jumped over 100 times now since his surgery and his knee is doing great thanks to a lot of effort by him, his surgeon, and his physical therapist. This is a direct quote from John himself, "Like the Bionic man Dr. Graham made me better than I was. It has been years now since the ACL operation and my leg is just fine. Thank you."