ACL reconstruction

Definition

ACL reconstruction is surgery to rebuild the ligament in the center of your knee with a new ligament. The anterior cruciate ligament (ACL) keeps your shin bone (tibia) in place. A tear of this ligament can cause your knee to give way during physical activity.

Alternative Names

Anterior cruciate ligament repair

Description

You will probably receive general anesthesia right before surgery. This means you will be asleep and pain-free. Sometimes, other kinds of anesthesia are used for this surgery.

The tissue that will replace your damaged ACL will come from your own body or from a donor. A donor is a person who has died and, before death, chose to give all or part of his or her body to help others.

The procedure is usually done by knee arthroscopy. With arthroscopy, a tiny camera is inserted into the knee through a small surgical cut. The camera is connected to a video monitor in the operating room. Your surgeon will use the camera to check the ligaments and other tissues of your knee.

Your surgeon will make other small cuts around your knee and insert other medical instruments. Your surgeon will fix any other damage found, and then will replace your ACL by following these steps:

At the end of the surgery, your surgeon will close your cuts with sutures (stitches) and put a dressing on them. Most surgeons take pictures during the procedure from the video monitor so that afterward you can see what was found and what was done.

Why the Procedure Is Performed

NOT treating a torn ACL can lead to tissue damage and early arthritis. ACL reconstruction may be recommended for these knee problems:

Before choosing to have this surgery, you should understand the time and effort it will take for you to recover. You will need to stick to a program for 4 to 6 months before you can return to full activity. The success of the surgery depends on how well you stick with your rehabilitation program.

Risks

The risks from any anesthesia are:

The risks from any surgery are:

Other risks from this surgery are:

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the 2 weeks before your surgery:

On the day of your surgery:

After the Procedure

You will probably go home the day of your surgery. You may have to wear a knee brace for the first 1 to 4 weeks. You also may need crutches for 1 to 4 weeks. Most people are allowed to move their knee right after surgery to help prevent stiffness. You may need medicine to manage your pain.

Physical therapy can help many people regain motion and strength in their knee. Therapy can last 2 to 6 months.

How soon you return to work will depend on the kind of work you do. It can be anywhere from a few days to a few months. A full return to activities and sports usually takes 4 to 6 months.

Outlook (Prognosis)

ACL reconstruction is usually very successful. A torn ACL used to end the careers of many athletes. Now, improvements in the surgery and in rehabilitation provide much better results. These improvements include less pain and stiffness, fewer complications with the surgery itself, and faster recovery time. Most people will have a stable knee that does not give way after ACL reconstruction.

References

Phillips BB. Arthroscopy of the lower extremity. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 48.

Honkamp NJ, Shen W, Okeke N, Ferretti M, Fu FH. Knee: Anterior cruciate ligament injuries in the adult. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 23, section D.

Amy E, Micheo W. Anterior cruciate ligament tear: Knee and lower leg. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 55, section 7.