ACL Reconstruction – They aren’t all the same!

Each orthopedic surgeon has their specific way of doing an Anterior Cruciate Ligament Reconstruction (ACLR). I think it is important to ask your doctors (It is important to get more than one opinion when considering this surgery) the following questions:

How many ACLR’s do you perform annually? 

I think this is an important question because if you are a semi/professional sports person or if you are doing sports that involve pivoting, changing of direction or jumping (soccer, basketball, field hockey, martial arts) you need to give your knee the best chance going forward if you would like to continue with the sport you love and avoid re-injury or chronic pain.

Since I tore my ACL in November 2018, I have consulted with 4 different orthopedic surgeons. The first two doctors I saw told me they only did 20-40 ACLR annually, the third and fourth doctors were doing 100-140 annually. The varying number of surgeries has nothing to do with their expertise but more to do with sporting population size etc. For example, Australia has the highest numbers of ACL reconstructions annually. But Australia is also one of the most active countries in the world, so that makes sense.

Which graft type do you use? 

When this injury does occur, the athlete has some serious decisions to make including which graft to choose for the reconstruction. Often, people leave that decision up to the orthopedic surgeon without really analyzing if it is best for their lifestyle, age and goals.

Next, I would like to explain the difference between an autograft and an allograft. An autograft is your own tissue. An allograft is the tissue of a cadaver.

The most common choices are a hamstring tendon, patella tendon, quadriceps tendon autograft and a patella tendon allograft. It is important to discuss these options in detail with your surgeon. The research and debate between the hamstring and patella autograft will continue, as there is a lot of research going into the re-injury rates as well as post-surgery pain. I decided to go with the hamstring autograph. Its known to be very painful and it has lived up to that reputation. But with correct management, 8 days post-op I am already off the analgesics.


– Cardeux Nel, Physiotherapist