Smaller incision offers big benefits in ACL surgery

An alternative to traditional anterior cruciate ligament surgery is becoming more popular because it gives the knee more stability and uses a much smaller incision.
The newer approach takes a tendon from a cadaver, which is called aligraft, and uses a double bundle of that tendon to repair the ACL.

“It’s having a great track record,” said Dr. Joseph Ciotola, an orthopedic surgeon at Mercy Medical Center in Baltimore, noting that the aligraft procedure uses tiny, keyhole-size incisions and takes less time, since surgeons don’t have to harvest the graft.

The anterior cruciate ligament (ACL) is part of the system of ligaments that stabilize the knee; athletes in sports with a lot of pivoting and cutting, or contact, can tear the ACL.
The traditional approach for a torn ACL takes a graft from the hamstring or from the interpatellar tendon that runs between the kneecap and lower legbone and uses that to repair the torn tendon, said Dr. Ciotola, who is a graduate of Mount St. Joseph High School.

Taking the interpatellar tendon is not without risk, though; some patients develop chronic knee pain and it increased the risk of breaking the kneecap, which happened to football player Jerry Rice after he had the surgery.

Because the aligraft surgery uses two grafts in a double bundle, it makes the knee more stable, with a more natural feel.

Dr. Ciotola said that with traditional surgery, athletes can return to play but when they pivot or turn they sometimes feel the knee slip.

“They can play through it, but it’s not quite right,” Dr. Ciotola said.

The newer surgery leaves the knee feeling more natural, which will give a player the confidence to play at full speed.

“Giving them better rotational control will let them play to their limit and give them their speed back,” Dr. Ciotola said.

But many athletes still opt for the traditional surgery because they can return to playing sports more quickly – six months instead of the seven to nine months required for the aligraft.

While an ACL tear devastates athletes, Dr. Ciotola reminds them that “it’s a season-ending injury, not a career-ending injury.” He cites the example of Jamal Lewis, who not only returned to the Ravens but rushed for more yards afterward.

“I always tell people that,” Dr. Ciotola said.

Catholic Review

The Catholic Review is the official publication of the Archdiocese of Baltimore.