Anterior Cruciate Ligament (ACL) Surgery
Anterior Cruciate Ligament (ACL) Surgery
Surgery for anterior cruciate ligament (ACL) injuries involves reconstructing or repairing the .
- graft to replace the . The most common are autografts using part of your own body, such as the tendon of the kneecap (patellar tendon) or one of the hamstring tendons. Sometimes the quadriceps tendon from above the kneecap is used. Another choice is allograft tissue, which is taken from a deceased donor. reconstruction surgery uses a
- Repair surgery typically is used only in the case of an (a separation of the and a piece of the from the rest of the ). In this case, the bone fragment connected to the is reattached to the .
arthroscopic surgery). In some cases, it is done by cutting a large incision in the (open surgery).surgery is usually done by making small incisions in the and inserting instruments for surgery through these incisions (
In reconstruction of a partial or complete tear of the footnote 1 Some experts believe that surgery should be delayed until the swelling goes down, you have regained in your , and you can strongly contract (flex) the muscles in the front of your thigh (quadriceps).footnote 1 Many experts recommend starting exercises to increase and regain strength shortly after the injury., the best time for surgery is not known. Surgery immediately after the injury has been associated with increased fibrous tissue leading to of motion (arthrofibrosis) after surgery.
In adults,is not a factor in surgery, although your overall health may be. Surgery may not be the best treatment for people with medical conditions that make surgery a greater risk. These people may choose nonsurgical treatments and may try to change their activity levels to protect their knees from further injury.
Many orthopedic surgeons use arthroscopic surgery rather than open surgery for ACL injuries because:
- It is easy to see and work on the knee structures.
- It uses smaller incisions than open surgery.
- It can be done at the same time as diagnostic (using arthroscopy to find out about the injury or damage to the ).
- It may have fewer risks than open surgery.
During arthroscopic ACL reconstruction, themakes several small incisionsâ€”usually two or threeâ€”around the . Sterile saline (salt) solution is pumped into the through one incision to expand it and to wash blood from the area. This allows the doctor to see the knee structures more clearly.
Theinserts an arthroscope into one of the other incisions. A camera at the end of the arthroscope transmits pictures from inside the to a TV monitor in the operating room.
Surgical drills are inserted through other small incisions. Thedrills small holes into the upper and lower leg bones where these come close together at the knee joint. The holes form tunnels through which the will be anchored.
If you are using your own tissue, thewill make another incision in the and take the graft (replacement tissue).
Theis pulled through the tunnels that were drilled in the upper and lower leg bones. The secures the with hardware such as screws or staples and will close the incisions with stitches or tape. The is bandaged, and you are taken to the recovery room for 2 to 3 hours.
What To Expect
Arthroscopic surgery is often done on an outpatient basis, which means that you do not spend a night in the hospital. Other surgery may require staying in the hospital for a couple of days.
You will feel tired for several days. Yourwill be swollen, and you may have numbness around the (incision) on your . Your ankle and shin may be bruised or swollen. You can put ice on the area to reduce swelling. Most of this will go away in a few days, and you should soon start seeing improvement in your .
To care for your incision while it heals, you need to keep it clean and dry and watch for signs of infection.
Physical rehabilitation after ACL surgery may take several months to a year. The length of time until you can return to normal activities or sports is different for every person. It takes most people at least 6 months to return to activity after surgery.footnote 2
Why It Is Done
The goal of ACL surgery is to restore normal or almost normal stability in theand the level of function you had before the knee injury, limit loss of function in the , and prevent injury or degeneration to other knee structures.
Not all ACL tears require surgery. You and your doctor will decide whether rehabilitation (rehab) only or surgery plus rehab is right for you.
You may choose to have surgery if you:
- Have completely torn your ACL or have a partial tear and your is very unstable.
- Have gone through a rehab program and your is still unstable.
- Are very active in sports or have a job that requires knee strength and stability (such as construction work), and you want your to be as strong and stable as it was before your injury.
- Are willing to complete a long and rigorous rehab program.
- Have chronic deficiency, which is when your is unstable and affecting your quality of life.
- Have injured other parts of your cartilage or meniscus, or other knee ligaments or tendons. , such as the
You may choose not to have surgery if you:
- Have a minor tear in your (a tear that can heal with rest and rehab).
- Are not very active in sports and your work does not require a stable .
- Are willing to stop doing activities that require a stable or stop doing them at the same level of intensity. You may choose to substitute other activities that don't require a stable , such as cycling or swimming.
- Can complete a rehab program that stabilizes your and strengthens your leg muscles to reduce the chances that you will injure your again and are willing to live with a small amount of knee instability.
- Do not feel motivated to complete the long and rigorous rehab program necessary after surgery.
- You have medical problems that make surgery too risky.
How Well It Works
A few people who have ACL surgery still have knee pain and instability and may need another surgery (revision ACL reconstruction). Revision ACL reconstruction is generally not as successful as the initial ACL reconstruction.
is generally safe. Complications that may arise from surgery or during rehabilitation (rehab) and include:
- Problems related to the surgery itself. These are uncommon but may include:
- Numbness in the surgical scar area.
- Infection in the surgical incisions.
- Damage to structures, nerves, or blood vessels around and in the .
- Blood clots in the leg.
- The usual risks of .
- Problems with the (loosening, stretching, reinjury, or scar tissue). The screws that attach the to the leg bones may cause problems and require removal.
- Limited , usually at the extremes. For example, you may not be able to completely straighten or bend your leg as far as the other leg. This is uncommon, and sometimes another surgery or manipulation under can help. Rehab attempts to restore a between 0 degrees (straight) and 130 degrees (bent or flexion). It's important to be able to get your straight so you can walk normally.
- Grating of the kneecap (crepitus) as it moves against the lower end of the thighbone (femur), which may develop in people who did not have it before surgery. This may be painful and may limit your athletic performance. In rare cases, the kneecap may be fractured while the is being taken during surgery or from a fall onto the soon after surgery.
- Pain, when kneeling, at the site where the tendon graft was taken from the patellar tendon or at the site on the lower leg bone (tibia) where a hamstring or patellar tendon is attached.
- Repeat injury to the (just like the original ). Repeat surgery is more complicated and less successful than the first surgery.
What To Think About
In an, repair surgery is always done as soon as possible.
Current research on the surgical treatment ofinjuries includes different techniques and places to attach ; different ways of securing the ; different types of , such as , muscle, or fascial from your body (autograft); and from a donor (allograft). When choosing a , you and your doctor may consider the following:
- Each type of graft and procedure has its own risks and benefits. Talk with your doctor about the type of graft and procedure that will be best for you.
- The success of surgery may be more dependent on the 's skill and preference than the type of used.
- Honkamp NJ, et al. (2010). injuries in adults. In JC DeLee et al., eds., Delee and Drez's Orthopaedic Sports Medicine: Principles and Practice, 3rd ed., vol. 2, pp. 1644â€“1676. Philadelphia: Saunders Elsevier.
- Micheo W, et al. (2015). tear. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 3rd ed., pp. 324â€“330. Philadelphia: Saunders.
Other Works Consulted
- American Academy of Orthopaedic Surgeons (2014). Management ofInjuries: Evidence-Based Clinical Practice Guideline. Rosemont, IL: American Academy of Orthopaedic Surgeons. http://www.aaos.org/research/guidelines/ACLGuidelineFINAL.pdf. Accessed June 12, 2015.
- McMahon PJ, et al. (2014). Sports medicine. In HB Skinner, PJ McMahon, eds., Current Diagnosis and Treatment in Orthopedics, 5th ed., pp. 88â€“155. New York: McGraw-Hill.
Current as of:
November 29, 2017