ACL Repair Orthopedic Surgeon – ACL Injury Specialist
The anterior cruciate ligament (ACL) is probably the most commonly injured ligament of the knee. Dr. Glashow routinely diagnoses and surgically repairs torn and injured ACLs at his Upper East Side specialty orthopedic surgery practice in NYC almost every day of the week. Many patients also seek the NYC orthopedic surgeon’s expertise in offering a second opinions pertaining to their ACL diagnosis. Chances are that if you are a professional athlete or know someone who has undergone ACL repair than Dr. Glashow performed their ACL repair surgery.
I’m a professional basketball player. I am writing this review out of honest gratitude. When I fractured my tibia, cracked my tibial plateau, and required my ACL to be reattached, I did some research and found Dr. Glashow who has glowing reviews in the professional basketball arena. He is truly an outstanding surgeon. As a professional team surgeon he “gets it”. He is very friendly, intelligent, credentialized, has an outstanding reputation among sports agents, and takes plenty of time to go over everything and answer questions, and has a really personable demeanor. He had a way of making me smile and joke around even when he gave me bad news (like you require surgery and can’t walk for 4 more weeks). All around the guy is good. I have very minimal scars and recovered quickly and my strength returned incredibly quickly. ~ YELP
Dr. Glashow and his associate orthopedic surgeons offer:
- ACL reconstruction and repair
- Robotic Partial or Unicompartmental knee replacement (medial, lateral, patellafemoral)
- All inside ACL reconstruction
- Revision ACL reconstruction
- PCL Repair Surgery (posterolateral corner of the knee)
- Torn meniscus repair
- 2nd Opinions
If you have suffered an ACL tear, PCL tear, MCL tear, torn meniscus or several other knee injuries, your doctor may recommend that you see a specialist arthroscopic knee surgeon. Knee arthroscopy is surgery that performed by making small cuts on your knee and looking inside using a tiny camera. The knee arthroscopic specialist, Dr. Jonathon Glashhow, has extensive experience performing knee arthroscopy and often recommends it as a less-invasive alternative to traditional open knee surgery. Trauma to the surgical area is greatly lessened and recovery time can be substantially diminished with arthroscopic knee surgery.
Lamarr Houston (Chicago Bears), patient of Dr. Glashow, 4 months post ACL surgery:
Dr. Glashow is recognized among national leaders in orthopedic surgery with a sub-specialist and experience in ACL reconstruction, revision, and repair surgery. His leadership is demonstrated by participation as instructors at local NYC meetings, national meetings, publication in peer-reviewed literature, and his continued participation in research to advance orthopedic services. His dedication to the advancement of orthopedics is centered on one goal: to directly optimize every patient’s quality of life that he ahs the opportunity to care for. Since opening his orthopedic surgery doors in NYC over twenty-five years, his patient satisfaction scores have been in the top 5% of the nation.
Please note: A doctor’s referral is NOT necessary from a General Practitioner to see our sports medicine or orthopedic surgery specialists for a consultation, 2nd opinion, or for treatment at our orthopedic practice – including ACL repair surgery.
Glashow Orthopedics offers full out of network insurance benefits for ACL Repair diagnosis and treatments (we will contact your insurance company and submit for you). You will enjoy the luxury and benefit of academic medicine in a top rated concierge environment without the hassle of long hospital waiting room times and paperwork.
- Knee arthroscopy is keyhole surgery of the knee
- It is normally performed through 2 or 3 small incisions at the front of the knee
- Most arthroscopies are done as a day case, out-patient procedure
- During knee arthroscopy, various procedures can be performed, such as cartilage trimming or repair
- What is the ACL?
ACL is the abbreviation for the Anterior Cruciate Ligament. This is one of the major stabilizing ligaments within the knee. It connects the thigh bone (femur) to the leg bone (tibia) and prevents abnormal movement (instability) occurring between the two. More specifically it provides rotatory stability to the knee to allow movements such as pivoting or sudden change in direction to occur without the knee giving way.
- Why are ACL injuries so common?
The knee is particularly vulnerable to injury. It is the joint between the two longest bones of the body, and the entire weight of the body is transferred to the foot through the knee. The knee is also more prone to injury because its stability decreases as it bends. The menisci and the ligaments provide less effective support to the bent knee.
- What does the inside of the knee look like and where is the ACL?
The knee joint contains bones, ligaments, muscle tendons, cartilage, nerves, and blood vessels. A fibrous joint capsule made of collagen surrounds the joint and encircles the end of each bone to give the knee stability.
- What are the signs and symptoms of an ACL injury?
A twist or strain has occurred which causes the following signs:
- “Pop” – Many patients, but not all, will hear or feel a “pop” when their ACL tears.
- Immediate onset of swelling – This is an indication that there is bleeding from the injured ligament.
- Pain – Most patients experience quite a bit of pain with an ACL injury.
- Instability – Patients often describe a buckling or unstable sensation in the knee.
- Your doctor has diagnoses you with this specific injury
- How is an ACL injury diagnosed?
The best in class NYC orthopedic surgeon will want to know the history of the knee injury and will determine if the signs and symptoms of an ACL injury are present.
After taking a history, the orthopedic surgeon will perform a physical examination. The doctor will perform manual tests on the knee to determine the amount of instability that exists. The Lachman Test, Anterior Drawer Test, and Pivot Shift Test are exams the doctor may use to see how much the tibia moves in relation to the femur.
Pain, swelling, and muscle spasms in the early stages of an injury may make it difficult for the doctor to diagnose the degree of instability with manual tests. An arthrometer, a machine that measures joint looseness in the knee, may be used.
X-rays can reveal signs of bone fractures, chips, or arthritis. Since X-rays can only show bone, a Magnetic Resonance Image (MRI) may be ordered to assess damage to soft tissue such as ligaments, tendons, and cartilage. An MRI is a non-operative procedure that allows the surgeon to determine the amount of damage to the ACL and any other structures of the knee.
If further testing is needed to clearly evaluate the problem, an arthroscopy may be recommended. During an arthroscopy, a tiny fiberoptic scope is inserted into the joint. The doctor uses this scope to visually assess the damage. In most cases, a diagnosis can be made without using this surgical procedure.
- How is an ACL injury treated?
The common recommendation for immediate treatment of an ACL injury is the well-known rule of RICE:
- Rest the knee by using crutches and keeping weight off of it
- Ice the knee
- Compress the knee with a wrap
- Elevate the leg
These measures will help control swelling. The doctor may also drain the joint of excess fluid to reduce pressure. After the initial injury symptoms have subsided and the diagnosis has been established, the orthopaedic surgeon will look at the history of the injury and the patient’s activity level to determine what treatment is best for the patient.
The two basic treatment choices that the NYC orthopedic Surgeon recommends for an ACL injury are:
- Non-Operative ACL treatment with rehabilitation and bracing
- Custom ACL surgery (numerous options that the orthopedist will discuss with you)
The ACL will not heal well on its own. Although this is true, about 20% of all patients will do well without surgery. A patient who does well without surgery is:
- Older or less active
- One who decreases his or her activity level
- One who avoids pivoting sports
These patients can expect a fair to good outcome just by learning to cope with their injury.
Patients who do not do well with non-operative treatment are usually described as:
- Younger or active patients
- Those who like to participate in pivoting sports or “unrestricted activity”
These patients are more at risk for re-injury. For these people, the likelihood of further damage to other ligaments or cartilage is quite high. A common re-injury is tearing a meniscus, which can lead to degenerative arthritis in the years to come.
Patients who are less active and do not participate in pivoting sports can continue to have a high quality of life with a good rehabilitation program. A partial tear to the ACL is usually treated in this manner.
ACL Surgical Treatment as offered by the Upper East Side, NYC, ACL Specialist Orthopedic Surgeon:
Patients for whom surgery is generally recommended:
- Active individuals who participate in any sport with pivoting – such as soccer, tennis, basketball, football, or skiing
- Patients who continue to experience instability after going through a rehabilitation program
- Those with injuries involving more than one ligament
It is important to consider the patient’s commitment to the rehabilitation program following an ACL surgical procedure (we will design a custom rehabilitation program for you). This is especially critical if a meniscal repair is also required. The patient must agree to carefully follow the recovery timetable outlined by the doctor.
The timing of an operation is important to prevent stiffness after surgery and obtain the best results.
- Is there a simple way to repair the damaged ACL without a reconstruction?
In a direct repair the ends of the torn ligament are sewn together. This procedure is usually not recommended, as the ends of the ligament do not heal reliably. Direct repairs of the ligament to the bone may heal; however, this, also is not always reliable.
Following surgery, the patient will be started on a structured rehabilitation program.
- How is an ACL injury treated?
Patient commitment and involvement are essential for a good functional result. The specific exercises and program timelines vary depending on the graft source used, and whether surgical repair to other injured structures was performed.
- The first phase of rehabilitation emphasizes the range of motion, which is critical to avoid knee stiffness.
- Crutches are used for the first 7 -10 days after surgery for comfort.
- Riding a stationary bike without resistance and pool exercises to increase motion usually begin about 7-10 days after the surgery.
- Driving is allowed when the patient is comfortable and has mobility, often as early as 2 weeks after the operation.
The patient returns for an office visit a few days after the surgery so the incision and range of motion can be checked.
- The second phase of rehabilitation incorporates strengthening and usually begins about 6 weeks after surgery.
- A sports chord (an elastic resistance strengthening tool) and the treadmill are initially used.
- Use of a bicycle or elliptical trainer is added at about 8 weeks.
- Strengthening using weights is allowed at 2 – 3 weeks.
- The third phase of rehabilitation adds sport-specific exercises
- Running is allowed at 4-8 weeks
- Pivoting and twisting activities can begin at 4 to 5 months.
This phase is customized for the patient’s sports and activity level.
The final phase of rehabilitation involves a supervised return to sports.This usually occurs approximately 6 months after reconstructive surgery.
- Are knee braces used after ACL reconstruction?
A post-operative brace is often used immediately after surgery. This is a large, sturdy brace that limits motion and helps protect the repair from an unexpected fall or twist. This type of brace is easily adjusted to accommodate the changes in the knee as swelling subsides.
A functional brace is lighter and less bulky and is often used during later stages of rehabilitation to protect the ACL reconstruction until complete recovery has occured.
- What type of follow-up is done after an ACL reconstruction?
Usually, about a 6-12 months following surgery, the doctor will evaluate the knee to measure the final results of the reconstruction in these areas: motion, stability, symptoms such as pain or swelling, how well the knee functions in daily living, and whether or not the patient has been able to return to sports.
Frequently Asked Questions about ACL Repair & Surgery
- Can the ACL heal by itself?
Some knee ligaments, such as the medial collateral ligament (MCL), heal reliably without surgery. Some partially torn ACLs, particularly in children and adolescents, may also heal without surgery. However, a complete tear of the ACL rarely heals. This is probably due to the amount of energy involved in the injury, the lack of blood supply, and the interior location of the ACL. The torn ACL may scar back to the intact PCL within the knee, but this rarely returns stability to the knee. In fact, even when the ends of a torn ligament are sutured together (called a primary or direct repair), the ligament does not reliably heal. Therefore, surgery for a complete ACL tear (an ACL reconstruction) involves replacing the ACL with other tissue (a graft).
- Is surgery always needed for an ACL tear?
Surgery is not required for all ACL injuries. Partial tears, in which a physical examination shows a relatively stable knee, may be treated with bracing and rehabilitation. Even some patients with complete ACL tears do not need reconstruction. These “copers” are typically older patients with lower physical activity, who do not participate in pivoting and cutting activities.
- Why should the ACL be reconstructed?
One reason to reconstruct the ACL is to provide knee stability that allows for return to activities and sports. Another reason is to provide knee stability in order to prevent more injury, such as a meniscal tear, which may eventually lead to degenerative joint disease.
- Is an MRI needed to diagnose an ACL tear?
An MRI is not always required to diagnose an ACL tear. An ACL tear can be accurately diagnosed with a physical examination. However, when the knee is very swollen and painful, an accurate examination can be difficult. Also, an MRI can be useful to reveal other associated injuries such as meniscal tears, a PCL tear, or injury to other supporting structures.
- Which is the best graft to use for an ACL reconstruction?
There are advantages and disadvantages to the many technical aspects of an ACL reconstruction including the type of graft, methods of securing the graft, and rehabilitation protocols. There is no clear consensus as to which graft is best. In the end, the surgeon’s experience with the chosen technique and the patient’s commitment to the rehabilitation program are probably more important factors in a functional outcome.
- When can I play sports again after ACL reconstruction?
Rehabilitation programs after ACL reconstruction are constantly evolving, shortening the return to sports. Most patients can start to return to their sports about 6 months after reconstruction.
Our team of NYC, New York orthopedic surgeons, specialty nurses, physiotherapists and support staff are dedicated to managing your specific orthopedic surgery and working together to ensure your needs are exceeded from consultation to following surgical discharge. Our goal is to deliver premium orthopaedic care using the latest techniques and advancements to achieve the best outcomes and help people return to pain-free, functional lives. Please read some of our NYC Orthopedic Surgeon’s Top Reviews.
Recovering from an anterior cruciate ligament reconstruction
After your ACL reconstruction you will be given pain killers to take home, ice packs and elevation are also helpful in the first few days. It usually takes about a year to make a full recovery from ACL reconstruction but this varies between individuals and case to case, so it’s important to follow your surgeon’s advice.
If you are an out of town patient seeking our orthopedic surgeon’s best in class knee surgery services, please review the following link for travel information: Out of town travel information for our NYC orthopedic knee surgery patients.
Our best in class ACL repair orthopedic surgeons pride ourselves with providing you highly personalized and comprehensive orthopedic care for your ACL. Our philosophy of direct orthopedic surgeon to patient care at every visit has made us one of the most trusted and respected orthopedic surgery practices on the Upper East Side in NYC. Feel free to contact us today, at any time, and start yourself on the road to recovery.