The anterior cruciate ligament (ACL) plays an important role in helping people maintain full mobility, so when this ligament tears, ACL reconstruction surgery is often required to replace the torn ligament. ACL reconstruction is performed by an orthopedic surgeon. During this surgery, the damaged ligament is swapped with another piece of tendon. Typically, this piece of tendon is taken from another part of the knee; however, a tendon from a deceased donor may also be used. This might sound scary, but in reality, ACL reconstruction is a common outpatient surgery that can be successfully performed without the need for large incisions.
ACL injuries are debilitating but common. If you’re a fan of sports, there’s a good chance that one of the athletes you admire has suffered a torn ACL at one point in their career. These injuries are commonly linked to activities that require sharp or sudden directional changes, which means athletes need to be cognizant of their physical health when competing at a high level. This isn’t to say that these injuries are reserved exclusively for athletes, but competing in athletics will increase a person’s chance of injury.
Who is a Candidate?
As we mentioned above, athletes and those with active lifestyles have a higher risk of tearing their ACL. Everytime a running back digs their cleats into the ground, feints left, and jukes right, they’re putting enormous amounts of stress on their knees. Over time, these types of sudden, powerful movement can damage the ACL overtime. Similarly, a basketball player who is required to constantly elevate to grab rebounds or dunk the basketball is putting significant weight on their knees everytime they land on the hardwood court.
The ACL connects the femur and tibia, providing vital stabilization to help boost mobility and maintain balance. When an athlete performs certain types of movements, it can place excessive pressure on the ACL, and all it takes is one bad accident to seriously damage it. Other examples of movements that can lead to a torn ACL include cutting (changing directions quickly), pivoting with a firm base, landing unevenly, stopping without decelerating gradually, and experiencing a direct impact to the knee.
Non-athletes may also suffer from a torn ACL, whether participating in a casual competition or engaging a day-to-day hobby. ACL tears are significantly less common for those with a sedentary lifestyle; however, these people are still at risk if they are involved in some sort of accident (i.e., slip and fall). Most athletes undergo ACL reconstruction so they can remain competitive in their sport. Physical therapy may be able to treat some ACL injuries, but this is a less effective option for those who want to regain full mobility and preserve their athletic prowess. Generally, an individual will undergo ACL reconstruction if they want to continue playing sports, have multiple damaged ligaments, have a damaged meniscus, or experience knee buckling. Age is also a determining factor.
What Happens During the Procedure?
During ACL reconstruction, the orthopedic surgeon will make several small incisions in the knee joint. An arthroscope (thin, tube-like video camera) will be fished through one of these incisions, giving the surgeon an unrestricted view of the surgical area. Small surgical instruments will also be inserted through these incisions to perform the surgery. In most cases, the patient won’t feel anything during surgery as they will be under general anesthesia.
The orthopedic surgeon starts by removing the torn ligament, which is then replaced with a graft of tendon. Holes, referred to as sockets or tunnels, are drilled into the fibula and tibia to help position the graft. Once secured, the graft provides the framework upon which new ligament tissue can grow. The surgeon then closes the incisions and waits for the general anesthesia to wear off. All in all, the surgery takes roughly one hour. Patients are able to return to their homes the very same day following surgery.
What Are the Risks?
As is the case with most surgical procedures, there are risks involved with ACL reconstruction. Fortunately, many of these risks are minor, and patient outcomes for ACL reconstruction are largely positive. Anytime a surgeon enters the human body through an incision, there is a chance for blood loss and infection. That said, these are preventable risks that can be mitigated by a vigilant team of orthopedic surgeons. Other risks include knee pain, stiffness, improper graft healing, and graft failure.
How is the Recovery Process?
The recovery process for ACL reconstruction is relatively simple. Of course, individuals will still have limited mobility while their graft takes root, but pain can be controlled with the use of over-the-counter drugs, including acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). If these medications don’t help, a doctor may prescribe stronger alternatives, such as meloxicam (Mobic, Vivlodex, others) and gabapentin (Neurontin). The surgeon may also request that the patient wears a knee brace to keep the graft secure.
Individuals should get a lot of rest, elevate their recovering leg, ice their injured knee frequently, and follow their surgeon’s advice to a T, especially when it comes to post-surgical care and cleaning the wound. Progressive physical therapy is the final component of the recovery process. The goal of this therapy is to ensure that the muscles around the knee have regained their strength and to provide some final rehabilitation exercises to bring the recovery process full circle.
ACL reconstruction can also be done with the hamstring if you’d like to lean more about that procedure.