An anterior cruciate ligament, or ACL, injury is a tear in one of the knee ligaments that joins the upper leg bone with the lower leg bone. The ACL keeps the knee stable.
Injuries range from mild, such as a small tear, to severe, such as when the ligament tears completely or when the ligament and part of the bone separate from the rest of the bone.
Without treatment, the injured ACL is less able to control knee movement, and the bones are more likely to rub against each other. This is called chronic ACL deficiency. The abnormal bone movement can also damage the tissue (cartilage) that covers the ends of the bones and can trap and tear the pads (menisci) that cushion the knee joints. This damage can lead to osteoarthritis.
Sometimes other knee ligaments or parts of the knee are also injured. This includes cartilage such as the menisci, or bones in the knee joint, which can be broken.
During arthroscopic ACL reconstruction, the surgeon makes several small incisions-usually two or three-around the knee. Sterile saline (salt) solution is pumped into the knee through one incision to expand it and to wash blood from the area. This allows the doctor to see the knee structures more clearly.
The surgeon inserts an arthroscope into one of the other incisions. A camera at the end of the arthroscope transmits pictures from inside the knee to a TV monitor in the operating room.
Surgical drills are inserted through other small incisions. The surgeon drills small holes into the upper and lower leg bones where these bones come close together at the knee joint. The holes form tunnels through which the graft will be anchored.
This is an outpatient procedure. While the operation only takes one to one and a half hours, between checking in and the anesthesia and the recovery time, plan on spending three to four hours at the Surgery Center.
This depends on the demands of your job. If your job is one in which you sit most of the day, you may return to work in a week. However if you are on your feet, placing demands on your knee, you will likely be out of work for four to six weeks.
Other injuries will be addressed at the same time as the ACL reconstruction. If the meniscus is torn at the rim, it will be repaired. Unfortunately, most menisci are torn in areas that will not heal. The torn portion is then removed, leaving as much of your normal meniscus as possible. Your rehabilitation program may change depending on associated injuries
You will have a choice of anesthesia. Most people are comfortable having a general anesthesia in which you would be sleeping during the operation. Another option is a spinal, in which you may sleep with the sedative medications given. We recommend you have a femoral nerve block which will decrease your pain in the period immediately after surgery and often for 10 to12 hours.
Your doctor will ask you to avoid any activity that puts your knee at risk of reinjury for 8 to 12 months. This is dependent on your rehabilitation and your ability to rebuild your quad. and hamstring muscles.
Your knee will be swollen after the operation. Ice, elevation, anti-inflammatory medications, will help decrease the swelling. It will continue to swell when you increase your activity for up to 6 weeks and by the 3 month mark the swelling should be minimal. You should be able to completely bend and straighten your knee by 4 to 6 weeks after the operation.