Anterior Cruciate Ligament Reconstruction

Overview

The Anterior Cruciate Ligament (ACL) is an important stabilizing structure within the knee joint, and is one of the most frequently injured – particularly in athletes. The ligament prevents excessive anterior movement of the tibia relative to the femur during flexion and extension of the knee.

When this ligament tears, the knee moves abnormally which feels uncomfortable and, if left untreated, can lead to degeneration of the knee cartilage and premature arthritis. Although ACL ruptures can be treated without surgery using a specialized brace, the majoMRI of the knee in the coronal section showing an intact ACL.rity of patients elect to undergo reconstruction of the ligament.

MRI of the knee in the coronal section showing an intact ACL.

MRI of the knee in the coronal section showing an intact ACL.

Patient Selection

Typically ACL injuries happen during sporting activity, and as such often happen in younger patients. Due to the fact that the abnormal movement of the knee after an ACL injury can quickly lead to development of arthritis in the knee, the younger the patient is, the more likely they are to benefit from reconstructive surgery.

In older patients who may already have started to develop some arthritic change in their knee, they may be advised to wear an ACL brace until such time as they require a knee replacement – a surgery that sacrifices this ligament anyway.

It is possible to have the injured ACL scar down and have partial function again after the injury even without any surgery. However, this is unpredictable and should not be relied upon to treat young, active patients.

Procedure

Reconstructing the ACL involves replacing the torn ligament with a substitute – most of the time this is a tendon taken from elsewhere in the body.

The options for this include hamstring tendon, quadriceps tendon or patella tendon – each choice has advantages and disadvantages, there is no clear superior choice. Your surgeon will advise you which graft may be best for you. You may also be offered an allograft tendon (tendon not from your own body).

The procedure involves first placing a camera in the knee to examine the joint surfaces, other ligaments and menisci, as ACL injuries frequently have other injuries such as meniscal tears associated with them.

Once these issues have been identified and treated, the knee is then prepared for the ACL graft. This will involve drilling holes in the bone through which the graft can be passed and eventually secured.

Once the holes have been prepared, the graft is passed through them and placed in position to function as the new ACL. It is then tensioned appropriately and secured in this tension using a surgical device that will vary depending on the graft choice.
Success Rate

ACL reconstruction is a unique surgery in that its success is not only determined by a successful surgical procedure, but a careful and diligent rehabilitation protocol thereafter. Return to sporting activity will depend on the individual patient and their chosen sport, but generally speaking the more intense the sport, the longer it will be before safe return to play – for example golfers may return within a few months, soccer players usually take 6 months or longer. However, the vast majority of patients who undergo reconstruction will be able to return to sporting activity eventually.

Summary

Anterior Cruciate Ligament reconstruction is a highly successful surgery that is very common in athletes of all sports, but can be of significant benefit to even non-athletes that sustain ACL injuries due to its protective effect against premature development of arthritis.

If you think, you may be a candidate for an ACL reconstruction, please arrange to see one of our specialist orthopedic surgeons who will be happy to see you in consultation and review your surgical options with you.

Dr. Vedant Vaksha

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.