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By Dr Ganesh Kumar Reddy Mundla
Consultant Orthopaedic Surgeon
Overview Procedure Benefits Risks Care at Medicover Frequently Asked Questions

Overview

ACL reconstruction surgery is a repair or reconstruction of the anterior cruciate ligament (ACL). The anterior cruciate ligament is an important soft-tissue structure in the knee that connects femur to the tibia. The anterior cruciate ligament stabilizes the knee joint when performing twisting and gliding actions. The cruciate ligament is essential in controlling the rotation of the knee during side stepping, pivoting, and landing from a jump.

An ACL injury often occurs in sports, but it can also occur if you twist your knee suddenly or receive a direct hit to the knee. Injury to your ACL is often accompanied by a "popping" noise and the feeling that your knee could give out from under you.

Other signs and symptoms of an ACL injury include:

  • Discomfort while walking
  • Knee swelling within the first few hours of the injury
  • Limited knee movement because of swelling and/or pain
  • Loss of full range of motion
  • Giving away sensation of knee
  • Difficulty in single leg standing/stance
  • Pain and discomfort in the knee

Procedure

Before the procedure

  • In order to undergo ACL reconstruction surgery,orthopaedic surgeons will perform a physical exam to check for swelling, tenderness, stability and other signs of injury.
  • Imaging tests such as MRI,X-ray may be required to assess possible secondary injuries (meniscus injury, collateral & PCL ligament injury).
  • You are advised to stop smoking to reduce your risk of developing complications and improve your long-term health.
  • Try to keep a healthy weight. You may develop complications if you are overweight or obese.
  • Regular exercise should help you prepare for the procedure, recover from it, and improve your long-term health. Before you start exercising, ask your doctor for advice.
  • Specific exercises to develop Quadriceps and Hamsting muscles strength and tone.

During the procedure

  • During surgical procedure, general or regional anesthesia is typically used. The anesthesiologist will give you the anesthesia to put you to sleep in the operating room.
  • The surgery will usually take approximately less than 90 minutes.
  • Most of the cases of ACL reconstruction surgery are carried out arthroscopically. An arthroscopy is a minimally invasive procedure where a special camera and surgical tools are inserted into the knee through small holes(Keyhole Surgery). The advantage is that the surgeon can access the joint and repair any injuries without fully opening the joint. This speeds up recovery due to less trauma to the knee.
  • The orthopaedic surgeon will create portals of entry for the arthroscope and surgical instruments by making small incisions around the knee joint.
  • The arthroscope is a small instrument inserted into the knee and a saline solution is delivered through it to expand the space around the joint. This makes room for surgical tools like the arthroscopic camera which displays pictures and sends video to a monitor so that the surgeon can see inside the knee joint.
  • The surgeon then examines the structures surrounding the torn anterior cruciate ligament, such as the meniscus and articular cartilage. The surgeon repairs any lesions in either of these soft tissues.
  • Usually graft is harvested from the patient him/herself. A graft is made by cutting a portion of tendon from another part of the patient's body. There are several common autograft sites, including the patellar tendon, hamstring tendon, Peroneous longus, IT band or rarely the quadriceps tendon. In case of an allograft, tendons come from a cadaver, and the surgery is shorter because the tendon is not removed from you.
  • The surgeon inserts the new ACL or graft through bone tunnels and fixes it to the femur(upper leg bone) and tibia(lower leg bone) using graft fixation implants like Suspensory button loops or interference screws.
  • At the end of surgery the incisions are closed by sutures/staples, and a sterile dressing is applied to complete the procedure.
  • You will be shifted to the recovery room following the surgery.

After the procedure

  • You'll be in the recovery room for a few hours while the anesthetic wears off. Your knee will be bandaged, and you may be given an ice pack to relieve pain.
  • You'll receive pain medicine, either orally or intravenously.
  • You must move your feet in the recovery room to improve circulation. Your surgeon may advise you to use crutches or a cane for two to three weeks. Within two weeks, the majority of patients are able to walk without crutches.
  • The surgeon may advise to wear a knee brace for the first few weeks to protect the knee.
  • When you're fully awake, you may be allowed to go home.
  • After surgery, there is a long rehabilitation program to regain full strength and stability. Most people do get back to playing full contact sport after 6-12 months of rehabilitation.

Benefits

ACL surgery helps to prevent damage to the cartilage and surrounding knee structures, which will otherwise take on more pressure since the ACL can no longer do its work. ACL reconstruction surgery stabilizes the knee and prevents strain and possible injury to the rest of the knee structures.

Risks

Most people do well after ACL reconstruction and have no major complications. However, complications occasionally occur during surgery or during the rehabilitation period. The most common complications include:

  • Swelling with fluid collection in the joint (Effusion)
  • Pain and discomfort for prolonged period
  • Joint stiff ness

Rear complicaions

  • Joint infection
  • Blood clot may form in the deep veins of the leg (deep vein thrombosis)
  • Arthrofibrosis (scar tissue)
  • Loosening of the graft

Care at Medicover

Medicover Hospitals offers advanced surgical and medical treatments to patients suffering from knee joint problems. Hospital employs world class technology, cutting-edge techniques, and advanced therapies to help patients live pain-free lives. Medicover Hospital is recognized for its expertise & experience in the treatment of knee joint conditions. We have the best orthopaedic surgeons and a dedicated team of staff who bring a wealth of experience and diverse expertise that has helped us grow into the best knee surgery hospital.

Citations

https://www.ucsfhealth.org/education/acl-reconstruction-surgery
https://orthoinfo.aaos.org/en/diseases--conditions/anterior-cruciate-ligament-acl-injuries/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3239388/
https://www.templehealth.org/services/treatments/acl-reconstruction-surgery
https://www.uptodate.com/contents/anterior-cruciate-ligament-injury-beyond-the-basics

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Frequently Asked Questions

1. How will I know that I've injured my ACL?

Your knee will most likely be swollen and painful if you have an ACL injury. When the injury occurs, you may hear or feel a 'pop,' and you may feel as if your knee will give way. You won't be able to move your knee as much, and there may be difficulty in standing and walking. Seek immediate medical advice if you have these symptoms.

2. Can I walk after ACL reconstruction?

Yes, you are encouraged to put weight on your leg as soon as possible and to move around. Walking aids may be required to support you at first. However, you should be able to walk normally in a couple of weeks.

3. Who performs ACL reconstruction surgery?

Experienced Orthopedic surgeon with Arthrocopy speciality training performs ACL reconstruction surgery.

4. Will I have to undergo physical therapy?

Physical therapy is an integral part of the entire torn ACL treatment. In most cases, you will have to go for your first session a day or two after the surgery. Your ACL doctor will then develop an appropriate schedule that will accelerate your quick recovery.

5. What are the benefits of ACL reconstruction surgery?

The ACL is necessary to provide stability during jumping, cutting, and pivoting. Once the knee has recovered from surgery, patients will experience a return to pre-injury levels of stability during these movements. The stability in the knee provided by ACL reconstruction also helps to prevent further injury to other knee structures and may delay the onset of osteoarthritis.