ACL Repair

About the Procedure

ACL reconstruction surgery is performed on patients who have suffered a tear or rupture of their anterior cruciate ligament (ACL). The ACL is a ligament located in the knee that connects the bottom of the thigh bone (femur) with the top of the tibia. Damage or displacement of this ligament results in high levels of pain and instability during physical activities involving the knee. The goal of ACL reconstructive surgery is to eliminate pain of use and restore as much functionality to the knee joint as possible.

Because this surgery occurs within the confines of a joint, it is often performed arthroscopically. General anesthesia is commonly recommended though spinal is acceptable as well. Several small incisions are made around the knee joint and small, specialized instruments are inserted through them.

One of these tools will always be an arthroscope, a fiber optic camera at the end of a narrow, flexible tube which feeds it's image back to a video monitor to give the surgeon a clear view of the surgical site. Prior to this however, a tube is inserted through one of the incisions and saline solution is pumped into the knee joint. This expands the soft tissue around the joint while also clearing it of blood and debris, making it easier for the surgeon to see the surrounding area.

First, the damaged ligament is removed. Next, tunnel-like holes are drilled into the bottom of the femur and the top of the tibia. A new ligament is pulled through these holes and fastened to the bone at either end with surgical screws. This ligament is typically taken from other tendons or ligaments in the patient’s body. The hamstring is a widely used donor site from which to obtain a suitable graft. In some cases, a graft can be obtained from the body of someone who is recently deceased.

Once the new ligament has been secured, the incisions around the knee are sutured closed and the surgery is complete. Within a few weeks of the surgery, the new ligament will have naturally bound itself to the tibia and femur.

What to Know Before the Procedure

ACL reconstruction surgery is very safe and represents the best opportunity to relieve pain and restore functionality similar to what one possessed prior to their injury. However, the rehabilitation process is long and challenging and may be more than some patients are capable or willing to undergo. Depending on the severity of the damage to your ACL and what kind of lifestyle you live, physical therapy may be a better option for you. While physical therapy will not restore as much functionality or stability as surgery, it is less expensive and less demanding. Talk to your doctor about whether or not surgery is the best path to take.

What to Know After the Procedure

The patient’s mobility will be limited for the first several weeks after surgery. Crutches will be required in order to walk. During this period, the patient should be doing “zero impact” exercises with their knee, as prescribed by their doctor, in order to stretch it out and begin building it back up. Rigorous rehabilitation therapy begins after about a month and a half, at which point the patient is just becoming capable of walking without assistance. Intense physical therapy can continue for as long as a full year. The time table for returning to high impact activities and sports differ from case to case, but the earliest return to this kind of lifestyle is typically 4 months after the operation.

Be sure to monitor your temperature, as well as the surgical sight for signs of infection. Keep the wounds from the surgical incisions properly dressed, clean and dry at all times to ensure proper healing. Contact your doctor immediately if you exhibit a hike in temperature or any discoloration or discharge from your wounds.

If you Need to Travel Outside of your Local Hospital

Due to the frequency of ACL injuries in professional sports, there is no shortage of highly qualified, experienced surgeons to perform this procedure. This makes it possible to consider other factors such as cost and ease of travel more heavily. While it takes several weeks to become ambulatory, with assistance travel is quite doable during this period. Keep in mind that both the procedure itself and the physical therapy are done on an out-patient basis, making it easy to plan travel around. Whether to have the procedure done domestically or internationally is strictly a matter of preference.