December 10, 2016
ACL Repair and ACL Reconstruction
A Brief Overview
The anterior cruciate ligament, also referred to as the “ACL,” is one of the major ligaments responsible for stabilizing the knee. You can think of it as a strong cable located in the middle of the knee joint that runs from the femur to the tibia. If torn, the anterior cruciate ligament will not heal on its own. Instead, it will cause swelling and lead to knee instability.
ACL reconstruction is a common minimally invasive surgery. With recent advances in arthroscopic technology, the procedure is performed through two small incisions.
Function of the Anterior Cruciate Ligament
The ACL is the major stabilizing ligaments in the knee and is called a “cruciate” ligament because it crosses through the joint. The ligament prevents the tibia from sliding abnormally on the femur. When an unusual movement occurs, it is called an “instability” and the patient is aware of the injury. Often other elements of the knee’s support structure, the meniscus or articular cartilage, for example, or other ligaments, are injured at the same time as a cruciate ligament injury and may also require attention during surgery.
Diagnosis of an ACL Tear
The diagnosis can often be made based solely on the circumstances leading to the injury. If possible, a sports medicine physician will examine the joint to explore the instability of the knee. Often times the joint is too swollen for a thorough exam to occur. Magnetic Resonance Imaging (MRI) is very helpful in displaying the exact injury to the soft tissue.
Treatment Options for an ACL Injury
Most sports medicine physicians will recommend conservative treatments at first so that the injury is not exacerbated. Rest, Ice, Compression, and Elevation or “RICE” for short.
Long Term Care
Although not everyone needs surgery for an ACL tear, most athletes or active individuals will want to undergo an arthroscopic procedure so they can return to their normal activities. Once an ACL injury occurs, many physicians will recommend that the athlete forgo competitive sports that require a lot of twisting and cutting.
For those that choose not to undergo arthroscopic surgery, further instability of the knee can result in additional joint damage to the other ligaments, meniscus, or cartilage. This often results in early arthritis or arthritic symptoms.
Indications for Minimally Invasive Surgery
Many people who suffer from an ACL injury are young athletes wishing to recovery quickly and return to their sport of choice. Even many non-athletes still want to return to an active lifestyle.
Some orthopedic surgeons may require patients to go through physical therapy prior to the reconstructive surgery. This strengthens the area around the injury.
Surgical Repair of the ACL
Surgical techniques have improved significantly over the last decade, and the procedure and recovery take significantly less time. The surgery is performed arthroscopically, meaning that two small incisions are made (approximately the diameter of a pencil) and the surgeon is able to work through the two ports. The damaged ligament is removed and then the bone is prepped to accept the new graft. This graft to replace the torn ACL is generally taken from the hamstring tendon or the patella tendon. The graft is prepared to take the form of a new ligament and passed through the bone. The tendon does not truly become a ligament, although it starts to function like one. If there are other elements damaged in the knee (meniscus or cartilage, for example), those issues are addressed and the tiny incisions are closed and dressed.
At Beacon Orthopaedics, ACL repair surgery is performed as an outpatient procedure, meaning that the patient can return home the same day. If a therapist has not already shown you how to properly use crutches, this will be done before the patient leaves for home. When a brace is involved, the physical therapist will also go over the donning and removal of the brace, as well as how to adjust the device.
A few common notes to ACL patients:
- Please leave your dressings on your knee until your post-op review.
- It is okay for you to put all your weight on your leg.
- Try to avoid anti-inflammatories for 10-days.
- Whenever you can, apply ice to your knee for 20 minutes at a time.
- Your post-op review appointment is usually scheduled for around 7-10 days.
Physical therapy can begin as soon as the following day, or after a few days, depending on how your recovery began following the operation. If you experience any redness, swelling, or increasing pain in or around your knee, please contact your physician immediately. To discuss ACL Repair and Reconstruction, schedule an appointment with one of Beacon’s Physicians.