anterior cruciate ligament (ACL) injuries involves
reconstructing or repairing the ACL.
ACL surgery is usually done by making small incisions in the knee
and inserting instruments for surgery through these incisions (arthroscopic surgery). In some cases, it is done by cutting a large incision
in the knee (open surgery).
ACL surgeries are done by
Many orthopedic surgeons use
arthroscopic surgery rather than open surgery for ACL injuries because:
Arthroscopic surgery is done under
regional (such as spinal) anesthesia or
ACL reconstruction, the surgeon makes several small incisions—usually two or
three—around the knee. Sterile saline (salt) solution is pumped into
the knee through one incision to expand it and to wash blood from the area.
This allows the doctor to see the knee structures more clearly.
The surgeon inserts an arthroscope into one of the other incisions. A
camera at the end of the arthroscope transmits pictures from inside the knee to
a TV monitor in the operating room.
Surgical drills are inserted
through other small incisions. The surgeon drills small holes into the upper
and lower leg bones where these bones come close together at the knee joint.
The holes form tunnels through which the graft will be anchored.
The surgeon will also make another incision in the knee and take the graft (replacement tissue).
The graft is pulled through the two tunnels
that were drilled in the upper and lower leg bones. The surgeon secures the
graft with hardware such as screws or staples and will close the incisions with stitches or
tape. The knee is bandaged, and you are taken to the recovery room for 2 to 3
During ACL surgery, the surgeon may repair other injured
parts of the knee as well, such as
menisci, other knee ligaments,
cartilage, or broken bones.
Arthroscopic surgery is often done on
an outpatient basis, which means that you do not spend a night in the hospital.
Other surgery may require staying in the hospital for a couple of days.
You will feel tired for several days. Your knee will be swollen, and you may have numbness around the cut (incision) on your knee. Your ankle and shin may be bruised or swollen. You can put ice on the area to reduce swelling. Most of this will go away in a few days, and you should soon start seeing improvement in your knee.
care for your incision while it heals, you need to keep it clean and dry and
watch for signs of infection.
Physical rehabilitation after ACL
surgery may take several months to a year. The length of time until you can
return to normal activities or sports is different for every person. It may
range from 4 to 6 months.1
The goal of ACL surgery is to restore
normal or almost normal stability in the knee and the level of function you had
before the knee injury, limit loss of function in the knee, and prevent injury
or degeneration to other knee structures.
Not all ACL tears
require surgery. You and your doctor will decide whether rehabilitation (rehab) only or
surgery plus rehab is right for you.
You may choose to
have surgery if you:
You may choose not to have surgery
A few people who
have ACL surgery still have knee pain and instability and may need another
surgery (revision ACL reconstruction). Revision ACL
reconstruction is generally not as successful as the initial ACL
ACL reconstruction surgery is generally safe.
Complications that may arise from surgery or during rehabilitation (rehab) and recovery
In an avulsion fracture, repair
surgery is always done as soon as possible.
of a partial or complete tear of the ACL, the best time for surgery is not
known. Surgery immediately after the injury has been associated with increased
fibrous tissue leading to loss of motion (arthrofibrosis) after
surgery.2 Some experts believe that surgery should be
delayed until the swelling goes down, you have regained range of motion in your
knee, and you can strongly contract (flex) the muscles in the front of
your thigh (quadriceps).2 Many experts recommend
starting exercises to increase range of motion and regain strength shortly
after the injury.
In adults, age is not a factor in surgery,
although your overall health may be. Surgery may not be the best treatment for
people with medical conditions that make surgery a greater risk. These people
may choose nonsurgical treatments and may try to change their activity levels to
protect their knees from further injury.
Current research on the
surgical treatment of ACL injuries includes different techniques and places to
attach grafts; different ways of securing the graft; different types of grafts, such as
tendon, muscle, or fascial grafts from your body (autograft); and grafts from a
donor (allograft). When choosing a graft, consider the following:
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
McMahon PJ, Kaplan LD (2006). Anterior cruciate ligament injuries section of Sports medicine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., pp. 180–183. New York: McGraw-Hill.
Honkamp NJ, et al. (2010). Anterior cruciate ligament injuries in adults. In JC DeLee et al., eds., Delee and Drez's Orthopaedic Sports Medicine: Principles and Practice, 3rd ed., vol. 2, pp. 1644–1676. Philadelphia: Saunders Elsevier.
Pinczewski LA, et al. (2007). A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: A controlled prospective trial. American Journal of Sports Medicine, 35(4): 564–574.
April 5, 2012
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
& Freddie H. Fu, MD - Orthopedic Surgery
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