ACL Surgery Demystified

into the Cut

Nov 1, 2000
Outside Magazine
The following Web sites can help you evaluate surgeons who specialize in knee surgery:

American Orthopaedic Society:
Steadman Hawkins Clinic:
American Academy of Orthopaedic Surgeons:

Biking, skiing, snowboarding, and trail running can all end disastrously with a hyperextended or twisted knee. Stretch your delicate anterior cruciate ligament beyond its tensile strength and a distinct champagne-bottle pop will likely follow. Not good; it's the auditory calling card of a torn ACL. "With a small tear, if there is no looseness in the joint, you could just do rehabilitation," says Richard Steadman, Picabo Street's orthopedic surgeon, who may have just saved you $20,000 in surgical costs. "But a full tear that weakens the joint will require a full reconstruction."

If you're in for the latter, there are two ways to go. World-class athletes almost universally prefer Steadman's method of using strands from the patellar tendon (see knee diagram, above), rather than the more common approach of grafting the hamstring tendons, to build a new ACL. "We did a study that found the [hamstring] is used throughout the ski turn," Steadman says. "You may lose something at the highest competitive level if you use that tendon."

The downside is that rehabilitation for a patellar graft can keep you off your feet longer and in a lot more pain than a hamstring graft, and it has the potential to cause tendinitis down the road. For the recreational athlete, stealing from your hamstring is the ticket, according to John Garrett, former chief resident of orthopedics at Harvard and founder of Atlanta-based Resurgens, which treats NFL players. "If you're aggressive, you can be off crutches in four to five days, on a bicycle by the end of a week, and back in your office," he says. "A patellar graft can keep you on crutches for up to six weeks." The success rates for both procedures hover in the 90-percent range. Either way, pick an orthopedic surgeon who subspecializes in knee operations and has a high-volume practice. And keep in mind that surgery is just the first step to becoming the badass you once were. "You have to go into it with the idea that more than half the job is yours," says Steadman. "The surgery is two hours, but the recovery is six months."