What Makes Dr. Charles Ruotolo a Top ACL Surgeon on LI?

Dr. Charles Ruotolo is widely recognized for his advanced expertise in ACL reconstruction and sports medicine surgery. He also serves as an Associate Master Instructor of Arthroscopy, training orthopedic surgeons in advanced arthroscopic techniques.

As the founder and president of Total Orthopedics and Sports Medicine, he leads a trusted orthopedic team providing advanced care across Long Island. He also specializes in minimally invasive surgical techniques that may support faster recovery and reduced postoperative pain. Because of his positive surgical outcomes and commitment to patient care, he has been recognized as a Castle Connolly Top Doctor and a Newsday Top Doctor. Call 855-321-6784 to book an appointment with Dr. Charles Ruotolo.

Why Should You Choose Dr. Charles Ruotolo for ACL Surgery on LI?

With expertise in “All-Inside” ACL reconstruction, Dr. Charles Ruotolo focuses on restoring knee stability while minimizing surgical trauma and recovery time. This minimally invasive approach may help reduce postoperative pain and support a faster recovery. He also develops personalized treatment plans based on your anatomy, activity level, age, and long-term recovery goals.

In addition, he carefully selects the most appropriate graft type, such as an autograft (using your own tissue) or allograft (donor tissue), to match your specific needs. In fact, NIH research reports that the choice of graft and surgical technique can directly affect both recovery time and long-term outcomes after ACL surgery.

Along with his commitment to patient care, Dr. Charles Ruotolo has published multiple articles in leading peer-reviewed medical journals. He is also a fellow of leading medical organizations focused on sports medicine, arthroscopic surgery, and orthopedic care, including:

• Arthroscopy Association of North America (AANA)
• American Academy of Orthopaedic Surgeons (AAOS)

• International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine (ISAKOS)
• American College of Sports Medicine (ACSM)
• Alpha Omega Alpha Honor Medical Society
• American Medical Association (AMA)

Does Board Certification Matter When Choosing an ACL Surgeon?

Yes, choosing a board-certified ACL surgeon can help improve the safety and quality of your surgical care. Since ACL reconstruction is a complex procedure, you need a surgeon with advanced orthopedic surgery training and proven surgical experience. Board certification also confirms that the surgeon meets professional standards for patient safety, medical knowledge, and surgical care. As a result, you can make a more informed decision before surgery and throughout your recovery process.

How Long Has Dr. Charles Ruotolo Been Performing ACL Surgery?

Dr. Charles Ruotolo has been performing ACL surgery for more than 25 years. He graduated from New York Medical College School of Medicine in 1995. Then he completed his orthopedic residency program at SUNY Stony Brook in 2000. After his residency, he underwent fellowship training in sports medicine and shoulder surgery at the prestigious Sports Clinic of Laguna Hills in California under the tutelage of Wesley Nottage, MD. This advanced training helped him develop specialized advanced arthroscopic surgical skills and expertise in minimally invasive sports medicine procedures.

Throughout his career, Dr. Ruotolo has also held several leadership and teaching positions in orthopedic surgery and sports medicine, including:

• Program Director – Orthopedic Residency, Nassau University Medical Center (2017–Present)
• Chairman of the Department of Orthopedics at Nassau University Medical Center, NY (2005–Present)
• Clinical Assistant Professor of Surgery – New York Institute of Technology College of Osteopathic Medicine (2013–Present)
• Interim Program Director – Osteopathic Orthopedic Residency Program, Nassau University Medical Center (2015–2017)
• Acting Chairman – Department of Orthopedics, Nassau University Medical Center, NY (2004–2005)
• Attending, Director of Sports Medicine and Shoulder Surgery – Nassau University Medical Center, NY (2001–2004)
• Earned distinction as the top surgical student in his graduating medical student class of 210 students

How Does Dr. Charles Ruotolo Personalize ACL Treatment?

To design a personalized ACL treatment plan, Dr. Charles Ruotolo evaluates your age, activity level, career demands, and any knee damage, such as meniscus tears. He also reviews MRI results to assess the severity of the injury and the condition of the knee joint. Once he completes the evaluation, he designs a treatment plan based on your lifestyle, recovery goals, and long-term knee function.

For example, our knee specialist, Dr. Charles Ruotolo, may recommend non-surgical treatment options for older or less active patients with partial ACL tears. In contrast, younger athletes and patients who play high-impact sports, such as soccer or basketball, often need ACL surgery to restore knee stability. In such cases, he chooses the graft that best matches your activity level, recovery goals, and long-term knee function, such as:

Patellar Tendon (Autograft)

This graft uses tissue from your own kneecap tendon. It provides excellent knee stability and long-term support after ACL surgery. Since the graft uses your own tissue, we often recommend it for athletes and highly active patients who participate in demanding physical activities. However, some patients experience significant pain and a longer recovery after surgery.

Hamstring Tendon (Autograft)

In this procedure, surgeons use one or two hamstring tendons from the back of your thigh to create the graft. Then, they fold and prepare the tendon tissue into a durable four-strand ACL reconstruction graft. After that, the surgeon places the graft through small bone tunnels in the tibia and femur (the upper and lower leg bones that support knee stability).

Quadriceps Tendon (Autograft)

Dr. Charles Ruotolo often recommends a quadriceps tendon graft for athletes who participate in cutting and pivoting sports, such as football, basketball, and soccer. In fact, PubMed research on quadriceps tendon ACL reconstruction showed positive recovery outcomes in competitive athletes. The study included 44 athletes with an average age of 20.3 years, including both Division I and non-Division I players. Around 65.9% of the athletes were male, while 34.1% were female. After follow-up evaluations, researchers reported the following clinical outcomes:

• Return-to-Play Timeline: Researchers found an average return-to-play time of 240.5 days after surgery.
• Recovery Time by Competition Level: Division I athletes returned to sports an average of 255 days after surgery. In contrast, non-Division I athletes returned in about 234.6 days.
• Re-Rupture Rate: The study reported a 0% re-rupture rate after ACL reconstruction.
• Post-Surgical Joint Stiffness: Only 9.1% of athletes developed arthrofibrosis (joint stiffness) that required additional treatment.

Allograft

For older or less active patients, Dr. Charles Ruotolo often recommends allografts using donor tissue to replace the torn ACL. Since the procedure does not require tissue from your own body, patients usually experience less post-surgical pain. However, the graft often takes longer to heal and fully attach to the knee joint than an autograft.

Which Advanced ACL Surgical Techniques Does Our Surgeon Use?

Dr. Charles Ruotolo uses minimally invasive arthroscopic ACL reconstruction and graft-based ligament restoration techniques during surgery. He also performs advanced procedures such as Internal Brace augmentation and Bridge-Enhanced ACL Repair (BEAR) to improve knee stability and recovery. In complex cases, he may combine reconstruction, biologic augmentation, or robotic-assisted surgery. Here is how these advanced ACL surgical techniques help improve knee stability and support faster recovery after surgery:

All-Inside ACL Reconstruction

In this procedure, surgeons use the retrograde drilling (inside-out drilling) technique to preserve natural bone. Since the surgery causes less damage to surrounding tissue, you often experience less pain after surgery. This technique also supports faster recovery and improved knee function.

In fact, a NIH retrospective comparative study examined 104 patients who underwent primary ACL reconstruction. Researchers compared patients treated with the conventional full tibial tunnel technique and those treated with the all-inside ACL reconstruction technique. After analysis, they evaluated the following outcomes:

• Lower Pain Scores at 3 Months: Patients treated with the all-inside technique reported significantly lower VAS pain scores.
• Improved Knee Function: The all-inside group showed higher Lysholm and IKDC scores at 3 months after surgery.
• Earlier Return to Sports: Patients returned to sports an average of 13.25 months earlier than with the conventional technique (16.40 months).
• Less Anterior Knee Pain: Researchers found significantly lower rates of front knee pain in the all-inside group

Internal Brace Augmentation (FiberTape Augmentation)

An internal brace technique uses a strong suture tape to support your ACL graft during healing. It helps protect the graft from overstretching during early recovery. As a result, you may begin movement and weight-bearing activities with better knee stability and support.

Robotic-Assisted and 3D Image-Guided Surgery

During ACL reconstruction, 3D imaging and robotic guidance help improve surgical precision. With this technology, Dr. Charles Ruotolo identifies the most accurate graft and bone tunnel position before surgery. This detailed planning helps improve graft alignment, knee stability, and long-term knee function after surgery. Accurate graft placement may also reduce long-term wear on the knee cartilage.

In fact, research by Dr. Charles Ruotolo et al. showed that direct surgical visualization can improve the placement of fixation buttons during ACL reconstruction. In the study, researchers reviewed postoperative knee X-rays from 76 patients who underwent ACL reconstruction. They found that direct visualization led to more accurate placement of the fixation button than indirect techniques.

Bridge-Enhanced ACL Repair (BEAR)

Instead of replacing the ACL, the BEAR technique helps repair the original ligament tissue. In this procedure, surgeons place a bio-engineered scaffold between the torn ends of the ACL and inject it with the patient’s own blood. This process stimulates natural healing and tissue regeneration inside the knee joint. In fact, research published in Current Reviews in Musculoskeletal Medicine reported the following clinical outcomes after BEAR treatment:

• Full Range of Motion
• Satisfactory Patient-Reported Outcomes (PROMs)
• Low Complication Rate

Double-Bundle Reconstruction

Double-bundle ACL reconstruction rebuilds both ACL bundles (AM and PL) to restore natural knee biomechanics (joint movement and stability). During the arthroscopic knee surgery, the surgeon creates separate bone tunnels for the anteromedial (AM) and posterolateral (PL) bundles to improve front-to-back and rotational stability. As a result, you may experience more controlled knee movement and improved stability during sports and physical activity.

Physeal-Sparing (Pediatric) Techniques

Our surgeon, Dr. Charles Ruotolo, may recommend physeal-sparing ACL reconstruction techniques for children and teenagers with open growth plates. During this procedure, surgeons avoid drilling through the growth plates in the bones. This approach helps protect normal bone growth and lowers the risk of growth-related complications after surgery. At the same time, it restores knee stability for young athletes and active patients.

What Post-Op Pain Management Strategies Does He Recommend?

Dr. Charles Ruotolo often prescribes analgesics, such as Acetaminophen and NSAIDs, to help manage pain and swelling after ACL surgery. He may also prescribe opioids for short-term relief during early recovery. Beyond this, he may recommend crutches and a hinged knee brace to help prevent ACL injuries and reduce pressure on the healing knee. During recovery, Dr. Charles Ruotolo may recommend the R.I.C.E. protocol to help reduce discomfort and swelling after surgery, including:

• Rest: Limit walking to avoid excess pressure on the healing knee.
• Ice (Cryotherapy): Apply ice packs or cold therapy for 15–20 minutes to reduce pain and swelling.
• Compression: Wear compression bandages or stockings to control swelling and fluid buildup.
• Elevation: Keep your leg raised above heart level to help reduce swelling after surgery.

In addition, to promote safe healing, Dr. Charles Ruotolo provides a Post-Op ACL Reconstruction Recovery Guide for patients after surgery. This guide includes detailed instructions about icing schedules, safe pain medication use, brace support, activity restrictions, and recovery timelines after surgery. You can follow these instructions to manage swelling, protect the ACL graft, and support safer healing during recovery. If you need more personalized guidance, you can call 855-321-6784 to discuss your recovery with Dr. Charles Ruotolo at Total Orthopedics and Sports Medicine.

How Does Dr. Charles Ruotolo Support Smooth ACL Recovery?

Dr. Charles Ruotolo creates a structured recovery plan based on your healing progress. During early recovery, he provides nutritional guidance, activity restrictions, and light walking to restore full knee range of motion while helping reduce swelling after surgery. As healing progresses, Dr. Charles Ruotolo recommends strength exercises to rebuild the quadriceps and hamstrings before returning to sports and physical activity. He also guides you through the following balance and movement exercises to improve knee stability during activity:

• Heel Slides: Improve knee bending after surgery.
• Quad Sets: Strengthen the front thigh muscles.
• Straight Leg Raises: Build leg strength with less knee pressure.
• Hamstring Curls: Improve hamstring strength and knee support.
• Stationary Cycling: Restore knee movement and support circulation.

Does Dr. Charles Ruotolo Handle Revision ACL Cases?

Yes, Dr. Charles Ruotolo handles revision ACL cases for patients with failed or unstable ACL reconstructions. Since revision ACL surgery is more complex, he identifies the exact cause of graft failure, such as tunnel misalignment or ongoing knee instability. He also evaluates bone tunnels, knee alignment, cartilage damage, and any previous surgical hardware before planning treatment.

Before scheduling revision ACL surgery, Dr. Charles Ruotolo may recommend the following tests to identify the exact cause of graft failure:

Imaging Tests

Before ACL revision surgery, Dr. Charles Ruotolo may recommend a 3D CT scan (detailed bone imaging) to evaluate previous surgical tunnels in the knee. This scan provides highly detailed images that help measure the size and position of the old bone tunnels. In some cases, he may also order an MRI to evaluate the torn ACL and soft tissues inside the knee joint. Beyond this, standing or long-leg X-rays help evaluate the alignment of the entire leg from the hip to the ankle. These images can identify alignment problems before planning revision surgery, such as:

• Bow-Legged Alignment: Places extra pressure on the inner side of the knee joint.
• Knock-Kneed Alignment: Increases stress on the outer side of the knee joint.
• Uneven Weight Distribution: Causes imbalance during walking and knee movement.

Joint Aspiration (Arthrocentesis)

If Dr. Charles Ruotolo suspects an infection, he may recommend joint aspiration (removal of fluid from the knee using a needle). Then he tests the collected fluid to identify bacteria and signs of infection inside the joint. Since infection can weaken the ACL graft, early identification helps guide safe and more accurate revision surgery planning. This test also helps determine whether additional treatment, such as antibiotics or infection management, is needed before surgery.

Blood Tests

Blood tests help identify inflammation or infection before revision ACL surgery. These tests often include C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR), which measure inflammatory activity in the body. Dr. Charles Ruotolo reviews these results to check for hidden joint infection or other medical concerns, such as:

• Anemia: Low red blood cell levels may increase strain on the body during anesthesia.
• Blood Clotting Risks: Coagulation tests, such as PT/PTT and INR, help identify risks of excessive bleeding or blood clots after surgery.
• Kidney and Liver Function: Metabolic panels confirm the kidneys and liver can safely process anesthesia and pain medications.
• Blood Sugar Levels: Glucose testing helps reduce the risk of surgical site infections and supports safer healing after surgery.

Lachman and Pivot-Shift Tests

During the examination, Dr. Charles Ruotolo performs hands-on knee stability tests before revision ACL surgery. For example, the Pivot-Shift test helps identify rotational instability and abnormal knee movement during motion. Similarly, the Lachman test helps evaluate forward instability in the knee joint caused by ACL damage. In fact, a study published in the Journal of Korean Physical Therapy reported that the Lachman test had 81% sensitivity and 98% specificity for diagnosing partial ACL tears.

After reviewing the test results, he designs a personalized reconstruction plan that restores knee stability while addressing the challenges from the previous surgery. This approach also helps reduce the risk of repeated graft failure and supports better long-term knee function.

Book an Appointment with Dr. Charles Ruotolo for ACL Surgery in Long Island!

If you are considering ACL surgery for a knee injury, finding a trusted ACL surgeon can be difficult. You may worry about the surgeon’s experience, surgical techniques, and recovery outcomes. In such cases, many patients delay surgery, which can eventually lead to ongoing knee instability and a longer recovery process.

At Total Orthopedics and Sports Medicine, Dr. Charles Ruotolo uses advanced ACL reconstruction techniques to manage both primary and revision ACL cases. Before surgery, he discusses graft options, possible surgical risks, and recovery expectations to make an informed treatment decision. He also guides you through pain management support, activity restrictions, and return-to-sport progression. Call 855-321-6784 or visit our clinics in Syosset, Massapequa, East Meadow, Deer Park, or Commack for personalized treatment.

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