We just got a fax from the surgeon who evaluated our daughter saying she has a torn ACL and it is nonrepairable. Surgery is advised. If it’s not repairable, what do they do in surgery? Just remove the torn parts?

In this case nonrepairable may mean the ligament is too damaged to repair and reattach it. Instead reconstruction surgery is needed. A piece of tendon from some other part of the patient’s own knee (either the patellar tendon or the hamstrings) is harvested and used as a donor ligament.

Years and years ago, a torn anterior cruciate ligament (ACL) might have been removed and considered nonrepairable, but today, reconstruction can be done instead. No doubt your daughter will have a follow-up appointment with the surgeon at which time her treatment options will be discussed.

Today, surgeons can do an arthroscopic exam (passing a very fine needle with a tiny TV camera on the end into the joint) and see directly what’s going on. The exact location and degree of the ligament tear can be seen. Any other damage to the knee (e.g., other ligament tears, meniscal tears) can also be evaluated. Reconstruction usually refers to restoring the ACL along with repairing any other damage present.

If you are unable to attend the next visit with your daughter, consider a telephone consult with the physician in order to understand test results and treatment recommendations. This will give you a chance to ask any other questions that come to mind as well.