June 1, 2006 A new procedure for torn ACLs could keep athletes back in the game longer. The knee has two bundles of fibers connecting the thighbone to the shinbone, and the new procedure, called double bundle, repairs both instead of just one. Athletes regain better rotation and motion of the knee for a longer time.
ORLANDO, Fla.--One of the most common knee surgeries is the reconstruction of a torn ACL in the knee. A new way to repair a common sports injury could keep athletes back in the game longer.
When Barrett Woods heard the sound most athletes dread, he thought his basketball days were over. "It was a loud pop," he says, "and immediately I fell to the ground."
That pop was the sound of his torn anterior cruciate ligament, the ligament that helps the knee bend. Woods needed surgery, and then he learned of a brand new procedure to repair his ACL, called a double bundle.
"Double bundle surgery restores rotation ... better than a single bundle," orthopedic surgeon Freddie Fu, of the University of Pittsburgh Medical Center, tells DBIS.
And restoring that rotation means Woods can still shoot hoops.
The knee has two bundles of fibers connecting the thighbone to the shinbone. Traditional ACL repair only mends one of those bundles. During the new procedure at the University of Pittsburgh, Dr. Fu uses a patient's or donor tissue to replace both bundles, restoring knee rotation and better motion for many years to come.
"Maybe in five, ten years, you won't wear out your knee," Dr. Fu says. The rehabilitation period for the double bundle technique is the same as for single bundle repair, about six months to nine months for a full recovery.
Woods bounced back from his surgery in no time, feeling as good as new. "I'm doing phenomenal, you know," he says. "It's really like I never had the injury." ... A phenomenal recovery that's twice as nice.
BACKGROUND: The University of Pittsburgh Medical Center is using an innovative new approach to repairing one of the most common sports knee injuries: the torn anterior cruciate ligament (ACL).
ABOUT THE KNEE: The knee is made up of three bones designed to produce smooth, stable motion: the shinbone (tibia), the thighbone (femur) and the kneecap (patella). The bones are enclosed in the joint capsule, which is lined with a tissue that produces a thick liquid to keep the joint lubricated and nourished. The knee is kept in alignment by ligaments and tendons. The anterior cruciate ligament (ACL) is one of two major stabilizing ligaments of the knee joint. The other one starts at the back of the knee -- the posterior cruciate ligament. These two ligaments cross each other at the center of the knee. There is another set of stabilizing ligaments on either side of the knee as well, which stabilize the joint when the knee moves from side to side.
WHEN GOOD JOINTS GO BAD: A healthy knee bends easily, absorbs stress and glides smoothly so that we can walk, squat, or turn without pain. When the knee is damaged, it is less able to handle stress, causing pain and swelling. Injuries to the ACL are the most common. Often there is a loud "pop" -- the sound of the ligament tearing --followed by pain and immediate swelling. After those symptoms subside, the patient may still experience episodes of instability, often likened to walking on roller skates. The knee may feel loose. In serious cases, surgical repair may be required.
WHAT'S NEW: The ACL has a complex structure consisting of two different bundles. Most ACL repairs use a single-bundle reconstruction technique that uses metal or plastic screws to graft on tendons or tissue taken from healthy parts of the knee. These single bundle reconstructions have a success rate of 70 percent to 90 percent. UPMC's new "double bundle" technique restores the natural complexity of the knee, using tendons from another donor rather than hamstring tendons taken from the patient's own leg. Researchers believe the new double-bundle technique could result in even higher successful recovery rates, with the same rehab period. Both surgical approaches are followed by immediate physical therapy and protective bracing and crutches for the first few weeks. Light sports activities may be resumed after three months, with a return to contact sports around nine months later.
Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.