The anterior cruciate ligament (ACL) is one of four primary ligaments that provide knee stability. A ligament tear cannot heal on its own. The goal of ACL reconstruction surgery is to restore pain-free knee function and knee stability; and to prevent joint deterioration from further injury to the knee cartilage and other ligaments. Deciding to have reconstruction surgery depends on your age and activity level, the stability of your knee, and whether you have related knee injuries. Another important consideration is that lengthy rehabilitation is essential to successful recovery and return to pain-free function and requires the patient’s commitment.
While less active patients with a torn ACL can function well with rehabilitation and bracing; professional or competitive sports will benefit from ACL reconstruction. For these patients ACL reconstruction is the most appropriate treatment.
An Overview of ACL Reconstruction Surgery
ACL reconstruction surgery is generally outpatient minimally invasive surgery performed under general or regional anesthesia. Minimally invasive surgery provides a multitude of benefits and produces good outcomes by sparing healthy tissues; reducing tissue damage and bleeding; and scarring.
Surgery involves reconstructing or replacing the torn ligament with a tendon graft. The graft may be taken from the patient (an autograft) or from a donor (an allograft).
The surgery often takes less than two hours but will require several incisions, one to remove the tendon to be used for the graft, and several small punctures to insert the arthroscope and surgical instruments and to insert the graft into the knee. Once the graft is inserted, it is fixed with screws or stitches to the upper leg bone and the shin bone. All incisions are closed, and a sterile dressing is applied.
Autografts and Allografts
Autograft tissue is the safest and fastest-healing tissue and is the choice for young active patients. However, multiple studies report that both autografts and allografts provide similar outcomes. Allograft tissue transplants are not rejected by the body, so it is not necessary to use drugs to prevent the body from rejecting foreign tissue. However, there is a slight risk of infection which can be prophylactically prevented.
The source of the graft tissue and the surgical technique employed depend on the severity of the injury, and the surgeon’s preference of graft material and surgical method. The most common source of graft tissue is the patient’s patellar tendon which tends to heal well and has a proven record of successful outcomes. This is the gold standard for ACL reconstruction. Other sources of graft tissue include the patient’s hamstring tendon which studies report provides reduced post-operative pain and easier recovery; the patient’s quadriceps tendon; and a cadaver tendon from a tissue bank.
Other knee repairs
Repair of other knee injuries can be accomplished during an ACL reconstruction. This may include surgical repair of the meniscus (a piece of cartilage that acts as a shock absorber between the bones), that is often injured when the ACL is torn; reconstruction of other torn knee ligaments; and realignment of the kneecap.
After the procedure, in the recovery room you will receive pain medication to manage your pain and crutches so that you can stay off of the knee for several weeks while you heal.
After surgery you will undergo rehabilitation to restore function. Recovery can take up to 6 months to a year.