Ask the Expert: Dr. Robert Marx, Orthopedic Surgeon, Answers Your Questions on ACL Injuries
Q1: Do I really need to have surgery for my torn ACL?
Patients who participate in cutting and pivoting sports such as basketball, soccer and football have a very high chance of developing knee instability and giving way without surgery. This often leads to cartilage and meniscus damage. For older, more sedentary patients who are not participating in such sports, non-operative treatment may be an option. If they develop symptoms of instability that are not tolerable, surgery can be performed at that point.
Q2: What do you use for your tibial and femoral fixation? Allograft vs. autograft?
Interference screws are used most commonly; however there are many devices available for graft fixation.
Q3: How much stronger are bone – patellar tendon – bone grafts relative to other graft sources? How much sooner can one return to play (I have heard as little as 3 months post-op versus a year for allografts with autograft hamstring and quadriceps tendons somewhere in between)? How much tensile strength does the donor patellar tendon lose after the defect is scarred in? By return to play I meant high demand cutting sports with no restrictions.
Graft selection is controversial. It does not affect time to return to play. Allografts are not recommended for young athletes due to high re-tear rates which have been discovered in recent research. They are more suited to older adults who have less time spend on their recovery and who are generally at lower risk of re-injury due to a lower activity level.
Q4: I heard that ACL injuries are different for females versus males – is this true?
The injury is the same. However, it is up to six times more common in females.
Q5: My son tore his ACL playing high school soccer. How will this affect him later on in life?
Hopefully it won’t. Any patient who tears their ACL is at higher risk of knee arthritis, but it is certainly not a guarantee.
Dr. Robert Marx is an orthopedic surgeon at Hospital for Special Surgery. He does arthroscopic and open procedures for knee and shoulder problems as well as knee and shoulder joint replacement surgery. Dr. Marx also performs complex and revision surgical cases.