Ryan Tannehill, quarterback of the Miami Dolphins, recently reinjured his knee and underwent season-ending surgery to reconstruct his partially torn ACL. The ACL, or anterior cruciate ligament, is an extremely important stabilizer of the knee. It is one of four major ligaments of the knee and prevents anterior translation of the tibia with regard to the femur, and also aids in rotational stability. It can be torn in contact or noncontact injuries. Historically, complete ACL tears have been shown to not heal, and in order to restore stability of the knee, a reconstructive procedure is generally required. Partial tears do not always necessitate surgery, and may scar in on their own; however decision for surgery usually depends on presence of clinical instability. It appears that Tannehill’s initial presumptive partial tear was not deemed too serious, and he likely had decent stability on clinical exam to not warrant surgery at the time. Unfortunately, his ACL did not heal strongly enough to provide adequate stability for the knee, which led to his new injury. Now he has undergone ACL reconstruction surgery, which will keep him out of football until the 2018 season.
Anterior cruciate ligament reconstruction can be performed in a number of different ways. The goal is to replace the torn ACL with a strong graft attached at the femoral and tibial insertion points. Grafts may be autografts (from your own body) or allografts (from a cadaver). Autograft choices include bone patellar tendon bone, hamstrings, or quadriceps tendon. Each graft has its pros and cons and is chosen based on a number of patient and activity-related factors. Typically, autografts are used in younger, more active patients as they have slightly lower graft failure rates. Allografts may be chosen in other patients as there is no “donor-site morbidity,” or potential pain and dysfunction caused by harvesting a native tendon to use as a graft.
Recovery from ACL surgery is generally a long process. Return to sport is based on length of time from surgery (minimum 6 months, usually 9-12 months), and objective return-to-play functional testing scores. Physical therapy is an extremely important component to having a successful outcome.
A new and exciting development in the treatment of ACL injuries is the innovative technique of ACL repair with internal brace. Instead of having to replace or reconstruct the ACL requiring a lengthy recovery, repairing the torn ligament with a newly described technique has shown promise. Surgery is less traumatic and full recovery may be quicker. Long-term data is still being collected, but early results are very encouraging. For the right patient with the appropriate tear pattern (partial tear?), ACL repair with internal brace may be an attractive option. In hindsight, it may have been the better option for Ryan Tannehill months ago, which potentially could have allowed him to play this season.
Dr. Randazzo is one of the few surgeons in the area specifically trained to perform ACL repair with internal brace.