What you need to know about:

Anterior Cruciate Ligament (ACL) Reconstructive Surgery

Fast Fact

84%

Worth It Rating

Average Cost:

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Recovery Period:

Several weeks

Permanence:

Over 15-20 years

177

Doctors

Time it takes:

2-4 hours

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Anesthetize:

General Anesthesia

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Overview of

Anterior Cruciate Ligament (ACL) Reconstructive Surgery

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The Anterior Cruciate Ligament is one of four strong fibrous tissue bands called ligaments that hold together and support the knee. The ACL runs diagonally inside your knee between your thigh (femur) and shin (tibia) bones. Your ACL primarily keeps your knee stable when you turn, cut, twist and pivot. Unfortunately, it is the knee ligament most often injured. An ACL tear is one of the most common and devastating sports injuries. Reconstructive surgery is a common treatment option for anterior cruciate ligament (ACL) tears. During ACL surgery, the doctor will remove what remains of the torn ligament and install a replacement in the same location. In the last ten years, the techniques used in ACL surgery have changed significantly, and improvements have been made that now allow patients to recover from the surgery much faster than before.

Goals of

Anterior Cruciate Ligament (ACL) Reconstructive Surgery

The surgery aims to prevent the shinbone (tibia) from moving too far forward, and restore the normal functioning of the knee in order to prevent further damage to its surrounding cartilage.

Price of

Anterior Cruciate Ligament (ACL) Reconstructive Surgery

Average Cost

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Price Range

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Pros and cons of

Anterior Cruciate Ligament (ACL) Reconstructive Surgery

Pros

ACL surgery offers the best chance of returning to normal knee function. It usually allows people to return to sports and other physical activities that require a stable knee. Without surgery, there is a high risk of developing future damage in the knee. This may make more extensive knee surgery necessary. Most people who have the surgery enjoy long-term knee health.

Cons

Problems can develop during the surgery or recovery. About 20% may need future surgery on the knee. This is more likely in younger people and those who do not carefully follow postoperative instructions. Potential complications include:

- Allograft risks including transmission of infections. Allografts are tendons that come from a cadaver donor. There is a higher risk of bacterial infections and infections with HIV and hepatitis C with allografts. Allografts may also have a higher failure rate, but more research is necessary.

- Growth plate injury, which is a risk for children whose growth plates (at the ends of long bones like the leg bones) have not closed. This can lead to growth problems. It may be necessary to delay surgery to allow growth plates to close.

- Knee cap pain including pain behind the kneecap and pain when kneeling. This is most common with a patellar tendon graft—a graft using a tendon that attaches the shin and kneecap. Using a patellar tendon graft also increases the risk of kneecap fracture due to weakening of the harvest site on the kneecap. There is a slightly increased risk of knee stiffness with this graft as well.

- Instability, which can be a result of graft stretching or a rupture of the graft - Stiffness, which can lead to loss of full motion in the knee after surgery

- Surgical risks including bleeding, blood clots, and infection of the surgical site

How it works:

Anterior Cruciate Ligament (ACL) Reconstructive Surgery

The three main types of ACL surgery are known as single-bundle, double-bundle and selective bundle reconstructive surgery Single-bundle ACL reconstruction: Doctor usually choose this type of surgery to operate on a torn ligament that does not require rotation, or when the patient has only limited control of joint movement, such as after repeat surgery following previously unsuccessful surgery. Double-bundle ACL reconstruction: This method is the new standard for ACL reconstructive surgery. It is supported by a wealth of research which demonstrates that double-bundle ACL surgery can restore greater strength to a torn ACL that requires rotation, when compared with single-bundle surgery. Selective bundle reconstruction: This type of surgery is used in cases where many parts of the ACL have suffered injury. With selective bundle reconstruction, it is not necessary for the doctor to remove the whole of the ACL, but only the injured parts of it. This method uses natural fiber replacements, which helps to stabilize the position of the shinbone and the functioning of surrounding muscles, so that the patient can regain control of the bones of the leg.

Preparation before

Anterior Cruciate Ligament (ACL) Reconstructive Surgery

Pre - treatment

Do not eat or drink for around 6 - 8 hours before surgery. Do not take aspirin or other blood-thinning medications for at least one week before surgery. Patients should also inform their doctor if they are using any other medication. Undergoing physiotherapy before surgery helps the knee to return to its original functioning as quickly as possible. Patients who receive ACL surgery while the knee is still in pain or still swollen after injury usually have problems rehabilitating the knee following surgery.

Recovery after

Anterior Cruciate Ligament (ACL) Reconstructive Surgery

Post - treatment

Once you recover from the anesthesia, you should be able go home the same day. Before you go home, you'll practice walking with crutches, and your surgeon may ask you to wear a knee brace or splint to help protect the graft. Your doctor will give you specific instructions on how to control swelling and pain after surgery. In general, it's important to keep your leg elevated, apply a cold wrap or ice to your knee, and rest as much as possible. Medications to help with pain relief include over-the-counter drugs such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). Your doctor might prescribe stronger medications, such as meloxicam (Mobic), tramadol (Ultram, Qdolo, ConZip) or oxycodone (OxyContin, Roxicodone, others). If opioids are prescribed, they should be taken only for breakthrough pain as they have many side effects and a significant risk of addiction. Follow your surgeon's advice on when to ice your knee, how long to use crutches and when it's safe to bear weight on your knee. You'll also be told when you can shower or bathe, when you should change dressings on the wound, and how to manage post-surgery care. Progressive physical therapy after ACL surgery helps to strengthen the muscles around your knee and improve flexibility. A physical therapist will teach you how to do exercises that you will perform either with continued supervision or at home. Following the rehabilitation plan is important for proper healing and achieving the best possible outcomes.

Risks & side effects

Risks associated with use of an anesthetic. Numbness or weakness in the legs due to long-term posture changes. Bleeding during and after surgery. Damage to nearby organs during surgery, such as nerve endings, blood vessels and kneecaps. Infection of bones or joints, which may occur immediately or shortly after surgery.

FAQs:

Anterior Cruciate Ligament (ACL) Reconstructive Surgery

What are the important ligaments in the knee besides the ACL?

The posterior cruciate ligament (PCL). The PCL also links the thigh and shinbones inside the knee toward the back of the joint. PCL injuries are rare. The medial collateral ligament (MCL). The MCL connects the two bones outside the joint on the inner side of your leg toward your other knee. The lateral collateral ligament (LCL). The LCL runs on the outer knee opposite the MCL. It connects your thighbone to your fibula, the smaller bone in your calf.

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When is the procedure recommended?

ACL reconstruction is generally recommended if: You're an athlete and want to continue in your sport, especially if the sport involves jumping, cutting or pivoting More than one ligament is injured You have a torn meniscus that requires repair The injury is causing your knee to buckle during everyday activities You're young (though other factors, such as activity level and knee instability, are more important than age)

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What Are ACL Tear Symptoms?

When your ACL tears: -70% of those suffering an ACL tear feel or hear a pop. -You’ll feel pain that increases when you bend your knee or try to walk. It may hurt to put any weight on that leg. -You knees will usually swell quickly. -Your leg might feel unstable. This is because your shin can move forward beyond its natural range (called loss of anterior stability). Also swelling and pain in your quadriceps (front of thigh) may keep the muscle from working properly. -Your range of motion might be severely limited. It will be painful to straighten your leg.

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How Much Ability Will I Recover?

Following reconstruction surgery and with full completion of rehabilitation and return-to-sport training, you can recover greater than 90 percent of your preinjury functionality as measured by commonly used sports outcome scores. However, this depends on your body, injury, graft choice and commitment to prehabilitation and rehabilitation. As you go through rehabilitation, continue to be evaluated and discuss your progress with your physical therapist and athletic trainer.

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Can I Retear My Reconstructed ACL?

Yes. Even the best reconstruction surgery cannot eliminate the possibility of a retear. See the reinjury risk section and calculators to see how graft choice for your ACL reconstruction affects your retear possibility. You can reduce your retear risk by completing full pre-surgery (prehab) and post-surgery rehabilitation programs plus specific return-to-sport training.

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