The anterior cruciate ligament (ACL) in the knee is used to stabilize and balance the femur and the tibia. The anterior cruciate ligament is at the center of the knee, forming an X- shape along with the posterior cruciate ligament.

Tearing of the ligament causes serious damage to the knee, which usually does not allow athletes to return to normal activity. If the rupture is not treated, knee subluxations can cause damage to additional parts of the knee such as cartilage or meniscus, and eventually accelerate the appearance of degenerative changes- arthritis of the knee.

Any rupture of the anterior cruciate ligament requires activation and restoration of the knee. The structure of the knee and the joint fluid do not allow the anterior cruciate ligament to regenerate and re-attach itself, and the persons affected need to change their activity habits or seriously consider surgery to reconstruct the anterior cruciate ligament.

Instead of a torn ligament, it is necessary to attach an implant. There are two types of implants:

*An implant from the patient himself, taken from an internal flexor of the knee, usually from the same leg.
*An implant obtained from an organ bank, called “allograft”.

Usually, and especially in a young and healthy person, Dr. Suzanna Horovitz prefers to use self-implantation. This type of implant is usually stronger, more durable, and  implant’s intergration in the knee is better.

The implant is prepared for implantation, followed by an arthroscopy of the knee for reconstruction, accompanied by repair of meniscus or cartilage damage.

Special equipment is used to drill tunnels in the femur and tibia, through which the implant is transferred, so the location of the new implant will resemble the anatomical position of the original cruciate ligament, as it was prior to the injury.

After transferring the implant through the drilled channels, it is set on both sides by a “button”. Usually the removal of such button will never be necessary.

In the past, it was necessary to drill a full tunnel in the tibia, through which the transplanted tendon was transferred into the knee. In this method, two tendons of the internal knee flexors were required.

There is an advanced surgical technique for the reconstruction of anterior cruciate ligament called “All-Inside”.
This method does not require the drilling of a full tunnel in the tibia, but only a partial drilling. In addition, instead of taking 2 tendons, only one bent tendon is required. The advantages of this new method have a real impact on the patient’s recovery from surgery and his return to regular activity.

This technique allows Dr. Suzanna Horovitz to minimize the damage to the tibia and hip muscles, without compromising the quality of the anatomical reconstruction of the torn ligament, which has positive significance for the patient.

The result of this minimal surgery is easier recovery, significant postoperative pain reduction, and faster return to daily activity.

Therefore, Dr. Suzanna Horovitz recommends to wait until the swelling and the inflammation diminish, and a range of motions returns to normal before performing cruciate ligament reconstruction.

Dr. Suzanna Horovitz also recommends strengthening and balancing the leg before surgery, in order to improve and facilitate subsequent rehabilitation.

In the light of current surgical technique and advanced medical equipment, Dr. Suzanna Horovitz believes in an accelerated knee rehabilitation process, enabling the patient to return to active life in a relatively short period of time.

Accordingly, the patient will begin physiotherapy with a qualified physiotherapist the day after the operation, in order to reach the maximal results according to an orderly rehabilitation protocol provided to the patient after the reconstruction. On that day, the patient will also begin walking with full weight bearing on the leg.

In addition to reconstructive procedures, the knee is usually put in knee stabiliser during the first two weeks after surgery, especially during resting times, to help the patient maintain full streightening of the knee at the beginning of rehabilitation.