Anterior Cruciate Ligament Reconstruction Surgery

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.

 

Understanding the ACL and its Importance

The ACL is one of the major ligaments in the knee joint, crucial for stability during activities like running, jumping, and pivoting. It connects the thigh bone (femur) to the shin bone (tibia) and prevents excessive forward movement of the tibia in relation to the femur. Without a functioning ACL, the knee can feel unstable, making it difficult to perform everyday tasks and sports activities.

Causes of ACL Injuries: ACL injuries often occur during sports that involve sudden stops, changes in direction, or jumping. Common causes include sudden twisting motions, direct blows to the knee, or landing awkwardly from a jump. These movements can stretch or tear the ACL, leading to pain, swelling, and instability in the knee.

Why ACL Reconstruction Surgery? Not all ACL injuries require surgery, but for individuals who want to return to sports or activities that involve strenuous knee movements, reconstruction surgery may be necessary. The goal of surgery is to replace the torn ACL with a graft, typically from another part of the body or a donor. This graft serves as a scaffold for new tissue growth, eventually becoming a new ACL.

Preparation for ACL Reconstruction Surgery: Before surgery, you’ll undergo a thorough evaluation, including imaging tests like MRI scans, to assess the extent of the ACL injury. Your surgeon will discuss the procedure with you, including the type of graft to be used and any potential risks or complications. It’s essential to follow preoperative instructions, such as fasting before surgery and avoiding certain medications that can increase bleeding risk

ACL Reconstruction 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.

ACL Reconstruction Surgery 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.

 

Recovery and Rehabilitation

Recovery from ACL reconstruction surgery is a gradual process that requires patience and dedication to rehabilitation. Immediately after surgery, you’ll be given pain medications to manage discomfort, and you may need crutches to assist with walking. Physical therapy plays a crucial role in the recovery process, helping to restore range of motion, strength, and stability in the knee. Your physical therapist will guide you through exercises tailored to your specific needs and goals.

Returning to Activities: The timeline for returning to activities varies from person to person and depends on factors like the extent of the injury, the type of graft used, and individual healing abilities. Most individuals can expect to resume light activities within a few weeks after surgery, gradually progressing to more strenuous activities over several months. It’s essential to follow your surgeon and physical therapist’s guidance to avoid re-injury and optimize long-term outcomes.

 

Potential Risks and Complications

As with any surgery, ACL reconstruction carries risks, including infection, bleeding, and blood clots. There’s also a risk of graft failure or re-tearing of the ACL, particularly if rehabilitation protocols are not followed diligently. It’s crucial to discuss these risks with your surgeon and adhere to postoperative instructions to minimize complications.

 

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.

Do you have more questions? 

How long does ACL reconstruction surgery typically take?

ACL reconstruction surgery usually takes around 1 to 2 hours, depending on the complexity of the injury and the technique used.

Will I need to stay overnight in the hospital after ACL reconstruction surgery?

In most cases, ACL reconstruction surgery is performed on an outpatient basis, meaning you can go home the same day. However, some individuals may require overnight observation, particularly if there are concerns about pain management or other medical issues.

When can I expect to return to sports or physical activities after ACL reconstruction surgery?

The timeline for returning to sports or physical activities varies depending on factors such as the type of graft used, the extent of the injury, and your progress in rehabilitation. In general, most individuals can expect to return to sports within 6 to 12 months after surgery.

Will I be able to fully bend and straighten my knee after ACL reconstruction surgery?

Yes, restoring full range of motion in the knee is an essential goal of ACL reconstruction surgery. Physical therapy will focus on gradually increasing flexibility and strength in the knee joint.

Are there any long-term complications associated with ACL reconstruction surgery?

While ACL reconstruction surgery is generally safe and effective, there is a risk of long-term complications such as arthritis and decreased range of motion in the knee. However, these risks can be minimized by following rehabilitation protocols and maintaining a healthy lifestyle.

Can ACL reconstruction surgery be performed on older individuals?

Yes, ACL reconstruction surgery can be performed on individuals of all ages, including older adults. However, the decision to undergo surgery should be based on factors such as overall health, activity level, and goals for recovery.

What can I do to prevent re-injury after ACL reconstruction surgery?

To prevent re-injury after ACL reconstruction surgery, it’s essential to follow your surgeon and physical therapist’s recommendations for rehabilitation and gradually return to activities. This may include wearing a knee brace during sports and practicing proper technique to avoid sudden movements that could stress the knee.

Will I need to wear a knee brace after ACL reconstruction surgery?

Whether or not you need to wear a knee brace after ACL reconstruction surgery depends on factors such as the type of graft used, the extent of the injury, and your surgeon’s recommendations. In some cases, a knee brace may be recommended during sports or strenuous activities to provide additional support and stability.

Can ACL reconstruction surgery be performed if I have other knee injuries or conditions?

ACL reconstruction surgery can often be performed in conjunction with treatment for other knee injuries or conditions, such as meniscus tears or cartilage damage. Your surgeon will evaluate your knee thoroughly and develop a treatment plan tailored to your specific needs.

Will I be able to drive after ACL reconstruction surgery?

You may be able to drive after ACL reconstruction surgery once you are no longer taking pain medications that impair your ability to drive safely and your knee is stable enough to operate the pedals without discomfort. It’s important to follow your surgeon’s guidance regarding driving restrictions.

How can I manage pain and discomfort after ACL reconstruction surgery?

Pain and discomfort after ACL reconstruction surgery can be managed with medications prescribed by your surgeon, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids. Additionally, applying ice to the knee and elevating it can help reduce swelling and discomfort.

Will I need to wear a brace or use crutches after ACL reconstruction surgery?

The use of a brace or crutches after ACL reconstruction surgery depends on factors such as the type of graft used and your surgeon’s recommendations. Some individuals may require temporary bracing or assistance with crutches to support the knee during the initial stages of recovery.

What can I do to speed up my recovery after ACL reconstruction surgery?

To optimize recovery after ACL reconstruction surgery, it’s important to follow your surgeon and physical therapist’s recommendations for rehabilitation, including completing prescribed exercises, attending therapy sessions regularly, and avoiding activities that could stress the knee.

Are there any dietary or nutritional recommendations following ACL reconstruction surgery?

While there are no specific dietary or nutritional requirements following ACL reconstruction surgery, maintaining a balanced diet rich in vitamins, minerals, and protein can support healing and recovery. It’s important to stay hydrated and avoid excessive weight gain, which can put added stress on the knee joint.

Can I return to work or school after ACL reconstruction surgery?

The ability to return to work or school after ACL reconstruction surgery depends on factors such as the type of work or school activities involved and your surgeon’s recommendations. In general, individuals can expect to resume light activities within a few days to a week after surgery, gradually increasing activity as tolerated.

Will I need to undergo physical therapy before ACL reconstruction surgery?

Preoperative physical therapy may be recommended in some cases to improve knee strength, range of motion, and overall function before ACL reconstruction surgery. Your surgeon will determine if prehabilitation is necessary based on your individual circumstances.

How can I prevent ACL injuries in the future?

While it’s not always possible to prevent ACL injuries entirely, there are steps you can take to reduce your risk, such as maintaining strong muscles around the knee joint through regular exercise, using proper technique during sports and activities, and wearing appropriate protective gear such as knee braces.

Can ACL reconstruction surgery be performed if I have other medical conditions?

ACL reconstruction surgery can often be performed safely in individuals with other medical conditions, but it’s important to inform your surgeon about any preexisting health conditions or medications you’re taking. Your surgeon will assess the risks and benefits of surgery based on your overall health status.

Will I need to undergo rehabilitation after ACL reconstruction surgery?

Yes, rehabilitation is a crucial component of recovery after ACL reconstruction surgery. Physical therapy will focus on restoring strength, flexibility, and stability in the knee joint, helping you regain function and return to your desired level of activity.

How long does it take to fully recover from ACL reconstruction surgery?

The timeline for full recovery from ACL reconstruction surgery varies from person to person but typically ranges from 6 to 12 months. Factors such as the type of graft used, the extent of the injury, and individual healing abilities can influence the recovery process.

What should I do if I experience persistent pain or swelling after ACL reconstruction surgery?

If you experience persistent pain or swelling after ACL reconstruction surgery, it’s important to contact your surgeon for further evaluation. These symptoms could indicate complications such as infection or graft failure, which may require additional treatment

What are the potential risks and benefits of delaying ACL reconstruction surgery, and when is early intervention recommended?

Delaying ACL reconstruction surgery may increase the risk of further knee damage and instability, but early intervention may not be necessary in all cases, particularly if the patient does not have functional limitations or is not engaged in high-demand activities.

How does the cost of ACL reconstruction surgery vary, and what factors contribute to the overall cost?

The cost of ACL reconstruction surgery may vary depending on factors such as the type of graft used, surgical technique, hospital fees, anesthesia charges, rehabilitation costs, and insurance coverage. Patients should consult with their healthcare provider and insurance company to understand the potential costs involved.

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.

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