ACL reconstruction

Definition

ACL reconstruction is surgery to rebuild the ligament in the center of your knee. 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

Most people have general anesthesia right before surgery. This means you will be asleep and pain-free. Other kinds of anesthesia may also be used for this surgery.

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

The procedure is usually performed with the help of 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 cover the area with a dressing. You may be able to view pictures after the procedure of what the doctor saw and what was done during the surgery.

Why the Procedure Is Performed

If you don’t have your ACL reconstructed, your knee may continue to be unstable. This increases the chance you may have a meniscus tear. ACL reconstruction may be used for these knee problems:

Before surgery, talk to your doctor about the time and effort you will need to recover. You will need to follow a rehabilitation program for 4 to 6 months. Your ability to return to full activity will depend on how well you follow the 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

Most people can 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. This can help prevent stiffness. You may need medicine for your pain.

Physical therapy can help many people regain motion and strength in their knee. Therapy can last 4 to 6 months.

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

Outlook (Prognosis)

Most people will have a stable knee that does not give way after ACL reconstruction. Better surgical methods and rehabilitation have led to:

References

Phillips BB, Mihalko MJ. Arthroscopy of the lower extremity. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 51.

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.