Minimally Invasive Procedure Can Transform ACL Reconstruction

Health Minute     Winter 2018

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One awkward landing or hard pivot of the leg can lead to something no athlete ever wants to hear: ACL tear.

The anterior cruciate ligament (ACL) is one of the most crucial parts of an athlete’s knee – running through the middle of the knee and helping to hold the femur and tibia together. It plays a vital role in the mobility and stability of the knee, and when injured, means the end of an athlete’s season and possibly even their career.

ACL reconstruction can restore the stability of the knee, but historically has been an involved process – involving tendon grafts, multiple incisions to the leg, and a long recovery. However, an ACL tear may be losing its place as the most dreaded injury among young athletes with the advent of a new minimally invasive procedure called All Inside ACL Reconstruction, which significantly lessens pain, provides less scarring, and allows for an easier recovery.

“The benefits to my patients are that we are able to provide a minimally invasive approach to what has traditionally been a much more involved operation,” said James Klosterman, MD, one of several orthopedic surgeons at Premier Orthopedics who is performing All Inside ACL Reconstruction. “What we’ve seen from our patients is improved early recovery, markedly decreased postoperative pain, better range of motion sooner, and less scarring.”

About ACL Injuries

The ACL is one of the most commonly injured knee ligaments. It is estimated that up to 200,000 ACL injuries occur and about 100,000 ACL reconstruction surgeries are performed each year. The incidence of ACL injury is higher in individuals who participate in high-risk sports such as basketball, football, skiing and soccer, according to the American Academy of Orthopaedic SurgeonsOff Site Icon (AAOS).

About 70 percent of ACL injuries do not involve contact with another person. Rather, the injury is often “non-contact” and associated with deceleration coupled with cutting, pivoting or sidestepping maneuvers, awkward landings or “out of control” play, the AAOS said.

The traditional approach to ACL reconstruction requires larger incisions, and violates tissues in the front of the knee, which can cause increased stiffness or decreased range of motion and increased pain. All Inside ACL Reconstruction can be done through four button hole size incisions around the knee, but more importantly is a durable reconstruction that stands up to traditional methods, Dr. Klosterman said.

“When we see our All Inside ACL patients back at their first follow-up appointment most of them have dramatically less swelling and improved range of motion than someone who had the traditional surgery,” he said. “This allows us to be more aggressive in our therapy and even accelerate our patients in meeting certain goals.”

All patients are evaluated six months after surgery to determine if they are ready to return to play. Testing determines if their knee functionality is at the point where it can risk the demands typically placed on it through sports. Most athletes will require six to 12 months of recovery and therapy in order to be ready to return.

“The burning question every athlete has when they undergo an injury is whether they will be able to return to the sport they love,” Dr. Klosterman said. “My job is to do whatever I can to make that happen. It’s not always a possibility, but this minimally invasive approach to ACL reconstruction gives us a quicker picture of what their long-term diagnosis will look like and also helps provide a quicker recovery to that end.”

For more information on ACL injuries and surgery or to find a Premier Physician Network physician near you, visit

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