Anterior Cruciate Ligament (ACL) Reconstruction

The ACL or Anterior Cruciate Ligament is a strong ligament located in the anterior, or front portion of the knee. It runs from the femur (thigh bone) to the tibia (leg bone) connecting these two bones together. The purpose of the ACL is to control the movement of the knee joint. It acts to limit side-to-side motion as well as prevents the knee from straightening beyond its normal range of motion. Injuries to the ACL can occur in a number of situations, including sports, and can be quite serious, requiring surgery.

Preparation for Anterior Cruciate Ligament (ACL) Reconstruction

You will consult with your doctor and/or surgeon prior to your surgery. You will discuss your treatment options, and make a decision about which type of anesthesia to use during surgery. During this consultation, it’s important to ask any questions you may have.

Discuss with your doctor where the tendon that will be surgically implanted in your knee will come from. Typical sources for these tendons include:

• Patellar Tendon: the tendon that attaches the bottom of your kneecap (patella) to your tibia
• Hamstring: the tendon that connects the long muscles in the back of your leg to the back of your knee
• Quadriceps: a tendon from the front of the thigh. This type of graft is typically reserved for taller or heavier patients, or for people who have had previous unsuccessful grafts.
• Cadaver: tissue from a dead body. This procedure is called an “allograft.” (See Anterior Cruciate Ligament (ACL) Repair with Allograft).

Your doctor will give you complete instructions for the day of your surgery. Instructions may include fasting for six to twelve hours prior to surgery and refraining from using aspirin or blood-thinning medications.

Make sure to arrange to have someone come with you for your surgery. It’s helpful to have someone there to listen to post-operative instructions and to drive you home.

 Surgery for Anterior Cruciate Ligament (ACL) Reconstruction

• You will change into a hospital gown and be wheeled into the operating room on a gurney. An IV will be placed into your arm so doctors can administer medications, anesthesia, or sedatives for the procedure.
• Once the sample tissue is selected, it is either surgically removed from your body or prepared from a cadaver. The tendon is then outfitted with “bone plugs,” or anchor points, to graft the tendon into the knee.
• During surgery, your surgeon will make a small incision in the front of the knee so that an arthroscope (a thin tube outfitted with a small camera and surgical tools) can be inserted. This allows the surgeon to see inside your knee during the procedure.
• The first thing the surgeon will do is remove your torn ACL and clean the area. Then, small holes will be drilled into your tibia and femur so that the bone plugs can be attached with posts, screws, staples, or washers.
• Following the attachment of the new ligament, the surgeon will test your knee’s range of motion and tension to ensure that the graft is secure. Then, the opening will be closed with stitches, the wound dressed, and the knee stabilized with a brace.
• Patients typically go home on the day of their surgery.

Recovery for Anterior Cruciate Ligament (ACL) Reconstruction

Recovering from anterior cruciate ligament knee surgery can take up to a year.

• Rehabilitation is key to the success of ACL reconstruction.
• Immediately after surgery, you’ll be advised to take pain medications, keep your incision clean and dry, and rest. You’ll most likely have a follow-up appointment with your doctor or surgeon within a few weeks of surgery.

Here’s what to expect following ACL surgery:

• Some pain
• Restricted activity for several months
• Walking with crutches for up to six weeks
• Wearing a knee brace for at least one week

You can expect to regain range of motion in your knee within a few weeks of surgery. Athletes typically return to their sports within six to twelve months.

 

Risks for Anterior Cruciate Ligament (ACL) Reconstruction

Because ACL reconstruction is a surgical procedure, it carries certain risks, including:

• Bleeding and blood clots
• Continued knee pain
• Disease transmission if the graft comes from a cadaver
• infection
• Knee stiffness or weakness
• Loss of range of motion
• Improper healing if the graft is rejected by your immune system

Young children with ACL tears run the risk of growth-plate injuries. Growth plates at the ends of long bones in the arms and legs allow the bones to grow. Growth-plate injuries can result in shortened bones.

Doctors evaluate these risks when deciding if surgery should wait until the child is older and the growth plates have formed into solid bone.