What is the ACL?
The anterior cruciate ligament or ACL is one of four primary ligaments that help stabilize the knee and promote normal range of motion in the joint. The ACL connects the lower leg bone (the tibia) with the upper leg bone (the femur). The ligament is attached to the front side of the tibia and the back side of the femur, crossing at the knee joint with a second large ligament called the posterior cruciate ligament (PCL). ACL injuries are relatively common, especially among athletes. ACL surgery is performed when the ACL ligament is completely torn or when a partial tear is severe and causes instability or other knee symptoms.
What’s the difference between ACL repair and ACL reconstruction?
In a few instances when a partial tear is relatively minor but still requires surgery, the ACL may be repaired. A repair may also be performed when the ligament and (usually) a small piece off the bone it’s attached to have been torn away (called an avulsion fracture). In this case, the bone fragment is returned to its normal position along with the ligament. But in most cases, ACL reconstruction is required to remove the damaged ligament and replace it with a ligament graft. Most commonly, the graft is taken from elsewhere in your body, like your knee or your thigh. The graft is harvested during your ACL surgery. Less often, a donor graft may be used.
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What happens during ACL reconstruction surgery?
There are two approaches for ACL surgery:
- Open surgery uses a large incision over the knee to access, remove and replace the ligament.
- Arthroscopic surgery uses two or three small incisions around the knee. The surgeon uses a special scope equipped with a camera to see inside the joint, eliminating the need for larger incisions. Special instruments are also used to perform the surgery through these small incisions. Arthroscopic surgery is associated with faster healing and less discomfort compared to open surgery, but it’s not always the best choice.
Most ACL reconstructions are performed arthroscopically. Once the incisions are made, sterile fluid is pumped into the knee to gently expand the joint so the ligament and other structures are easy to see. An arthroscope is inserted into one of the incisions, and the tiny camera sends video images to a viewing monitor so the surgeon can get an “up close” view of the area.
Surgical drills are used to create small holes or tunnels through your leg bones. These channels will hold the ligament graft in place. The prepared graft is “threaded” through the holes, then secured to the bone using screws or staples. Before closing the incision, the surgeon carefully examines the knee to ensure it’s stable and flexible.
What happens after surgery?
Immediately after your surgery, a dressing will be applied to your knee and you’ll be taken to a recovery area for a little while so you can be monitored. Arthroscopic ACL surgery usually is performed on an outpatient basis, but in some cases, you may need to spend a day or two in the hospital. During your recovery, you’ll have physical therapy to promote healing and restore normal function to your knee. Complete recovery usually takes anywhere from six months to a year, but it varies from one person to another.
How will I know if I need ACL surgery?
Not all ACL injuries require surgery. Your doctor will perform a careful examination of your knee, including diagnostic imaging, to make sure surgery is the best choice for you. If you’re experiencing knee pain, instability or decreased range of motion in your knee, call Franklin Orthopaedics and Sports Medicine at (615) 771-1116 and schedule a consultation today.