ACL Repair/ Reconstruction

ACL (Anterior cruciate ligament) is one of the four ligaments that runs diagonally in the middle of the knee to provide rotational stability. The ACL prevents the tibia from displacing in front of the femur, but it is the only ligament that gets injured more commonly than the other three ligaments. Especially people who are engaged in high-risk sports such as football, skiing, basketball, soccer, and rugby are more prone to an ACL tear.

In maximum cases, ACL injuries occurring in different combinations are altogether damages, articular cartilage, meniscus or corresponding ligaments. Even in severe conditions, a patient can suffer bruises on the bone beneath the cartilage surface. ACL injuries can be diagnosed using MRI scan properly, which assist in choosing the line of treatment. However, an ACL tear cannot be healed on its own and need immediate surgery.

ACL Reconstruction 

If an ACL is fully torn then it is impossible to repair or reattach the ligament surgically; instead, the orthopaedic surgeon will go for rebuilding a new ACL, the procedure is known as ACL reconstruction. Today, it is the most popular technique to heal the injury, which cannot heal without any medical help.

Pre-Surgery Preparations

Before surgery, you might be advised to take a few sessions of physical therapy that will help in reducing pain and swelling and increase the range of flexibility and motion. A stiff knee creates complications in ACL reconstruction technique and proves to have slow recovery afterwards.

ACL reconstruction surgery- Procedure 

Your surgeon will use general anesthesia to perform the surgery so that you will be comfortable around the surgical procedure. The reconstruction surgery will be done following a few steps that may vary according to conditions. Here is the small guide to the process;

  • Firstly, small incisions will be made by a surgeon around the knee joint to make free access for the arthroscopic and surgical instruments.
  • Once the arthroscope is inserted into the knee, the surgeon will pass on saline solution to temporarily expand the space among the joints. The goal is to make enough space for arthroscopic camera and tools that will deliver the status through video to the monitor that will guide the surgeon throughout the process.
  • Now the surgeon will evaluate the area of injury and ACL tore that includes the region of articular cartilage, left and right meniscus. If any of these tissues are damaged, the surgeon will repair them on priority, first.
  • A new graft will be harvested to the patient’s knee. This graft is made from the particular section of a tendon from some other part of a patient’s body. Once prepared, it will be attached at each end to plugs of bone in between patella and tibia.
  • These newly formed plugs assist in supporting the graft that will later perform as the new ACL in the patient’s knee. The surgeon will insert the ACL into the femur bone and tibia while using a medical flexible wire guide.
  • Lastly, the screws were applied to fix the plugs of bone to secure it for longer run firmly. With time the caps will coordinate with the surrounding bones.
  • After the procedure is done, the instruments and arthroscopic camera will be removed, a wound will be covered with stitches.

Post-surgery Precautions

After the surgery, the patient will be shifted to the recovery room till the time he/she gets consciousness over anaesthesia. In maximum cases, ACL reconstruction is meant to be done as outpatient surgery, or it is possible to have to make a hospital stay for 1 to 2 days.

  • Before going home you will be guided to walking techniques with crutches. Even the surgeon may suggest you wear knee brace/ splint to support and protect the graft.
  • You have to follow precautions to control post-surgery swelling and pain which is natural to occur. Keep the position of leg elevated, apply an ice pack to your knee and don’t put stress.
  • Pain medications will be prescribed such as Advil, Tylenol or Aleve or sometimes stronger dosage. Don’t take without any advice as it may cause side effects.
  • Follow all the necessary instructions including the change of dressings on the wound, when to bathe, dietary plans, medications and other post-surgery aftercare.
  • Soon after the surgery, you will be directed to take physical therapy that will help to improve flexibility and strengthen the muscles around the knee. Take physical therapy for a specific period and learn to exercise to perform on your own.

Following the precautionary and post-surgery care plans will be led to a fast recovery and give positive outcomes out of reconstruction surgery.

Results

For the successful result of the ACL surgery, the patient needs to focus on complete rehabilitation that assists in restoring usual functioning and stability of the knee sooner. It will take (8 to 9) months to recover from the injury. You will be advised to strive to regain mobility of the treated knee as equal to the opposite knee, which is necessary for the circulation and bringing back the strength. However, you will have a complete direction of do’s and don’t from your concerned surgeon. For athletes, it will be advised to take a year’s rest to return into sports activities.