Dr. Ebraheim’s educational animated video describes the condition of ACL reconstruction can be complicated.
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ACL reconstruction can be complicated
The treatment of ACL tears can be difficult. ACL reconstruction can be complicated, especially if the patient has a meniscal injury, bone deformity, or posterolateral corner injury. The patient has a meniscus tear that requires repair and the ACL is also damaged, then an ACL reconstruction must also be completed. If the meniscal repair is completed without concomitant ACL repair, then the meniscus is likely to fail. In an ACL deficient knee, there is an increased anterior to posterior translation of the tibia, resulting in increased forces across the medial meniscus. The posterior horn of the medial meniscus is the most important structure for resisting anterior to posterior translation and it is more prone to injury if instability continues without ACL reconstruction. If the patient is found to have an ACL injury requiring reconstruction, the surgeon must also address injury to the posterolateral corner. If the posterolateral corner is left without repair, the ACL reconstruction is at risk of failure. If the posterolateral corner is injured, reconstruction cannot be completed unless the mechanical alignment of the limb is corrected. Malalignment increases forces across the reconstruction. If the limb is left malaligned, then the posterolateral corner repair is at risk of failure. For example, the varus knee should be considered for a high tibial osteotomy prior to posterolateral corner reconstruction. The treatment of ACL tears can be difficult in the usual treatment of an ACL tear is an ACL reconstruction after period of therapy to regain motion. In summary, any malalignment of the extremity should be addressed prior to addressing the posterolateral corner injury. If the posterolateral corner is injured, this requires reconstruction or repair prior to ACL reconstruction. And lastly, in the setting of a meniscus tear and an ACL tear, the ACL must be reconstructed prior to the meniscal repair.
