The anterior cruciate ligament or ACL is a primary component of the knee joint which contributes to anterior knee stability. Injury to the ACL usually relults in instability, especially with contact, twisting, or pivoting mechanisms, which may require surgical intervention.

Indications

The reason to reconstruct the anterior cruciate ligament is that the natural history of untreated ACL tears has suggested the progression of symptomatic instability leading to recurrent injury, damage to the menisci and the articular cartilage, and osteoarthrosis. Because not all patients who have an injury to the ACL have symptoms or progression to osteoarthrosis, it is accepted that not all such injuries warrant operative reconstruction. Patients most likely to benefit from a reconstruction include young persons who regularly participate in contact and pivoting sports or have torn their ACL in combination with other ligamentous injuries. This group can also be extended to include persons whose occupations require extensive knee loading on a daily basis. While age is generally not a limiting factor in performing an ACL reconstruction, we generally recommend that older patients attempt a trial of rehabilitation, and sometimes bracing, to determine if they have problems with knee instability prior to recommending an ACL reconstruction.

Procedure

Preoperatively, the surgeon must decide which type of reconstruction should be performed. The most common operative method involves the use of the patellar tendon as the graft. This can be done with the use of arthroscopic assistance to minimize the invasiveness of the procedure. Fixation of the chosen graft is done by fixing both ends of the graft in the femur and the tibia at their normal attachment sites.

Rehabilitation

In the immediate postoperative period, analgesics, ice compression, and elevation are used to decrease pain and swelling while restoring full motion in a timely manner. It is widely accepted that rehabilitation is critical to the success of treatment of the reconstructed ACL and intensive rehabilitation can help prevent early arthrofibrosis and restore strength and function. We have found that the most important postoperative item is to make sure that the patient gets the knee out straight (full extension) as soon as possible after surgery. Patients who achieve full knee extension immediately usually return back to sports and full function quicker than those who have difficulty in getting their knees out straight.

Standard protocol for ACL reconstruction

FAQ's

Q1. How long is the recovery period for this procedure?

A1. Initially, the patient is non weight bearing for 2 weeks. The patient can then wean off of the crutches when they can walk without a limp between weeks 2-6. Slow rehab will be allowed at this time while the bone is still healing in the tunnels. Activities are usually increased from weeks 7 through 12. Around week 12, some patients return to jogging. Patients may then return to sports at 5 through 7 months if they pass functional and strength testing.

Q2. Will I be able to bear any weight on this leg?

A2. Patients are instructed to use crutches in the immediate postop period until they are able to walk without a limp.

Q3. Will I need to be hospitalized after this procedure?

A3. This surgery is generally done as an outpatient procedure.

Q4. How will this procedure relieve my pain and increase the function of my knee?

A4. This surgery has an excellent chance of providing stability to the knee. Pain relief is variable and depends on its etiology.

Q5. Is it necessary to take time off work after this surgery?

A5. Most people are back to a desk job within 1-2 weeks after surgery. Light duty/limited walking is usually allowed at 4-6 weeks and no heavy twisting/turning is allowed for 4-6 months. Also patients are not allowed to drive for 3 weeks if thier right leg is affected and 1 week if their left leg is affected. This is due to published studies regarding driving reaction times and narcotics.

Q6. Will my medical insurance cover this procedure?

A6. Yes; with appropriate documentation of your condition.

Q7. Will I need physical therapy; if so, for how long?

A7. Yes, physical therapy is needed after surgery. The initial 1st few weeks are spent getting the quads firing, as well as full extension and flexion of the knee. Weeks 2-6 the patient works on range of motion. Weeks 6-12 patients usually can increase use of an excercise bike. The minimal amount of therapy visits are usually at weeks 1, 6, 12, and 5 months postop. Many patients can rehab themselves with the above noted visits to the therapist to make sure that they are doing the right excercises and progressing well.