ACL Reconstruction Surgery

The Anterior Cruciate Ligament (ACL) is a primary knee ligament located inside the knee joint behind the kneecap. Together with the posterior cruciate ligament (PCL) the ACL joins the upper leg bone in the knee joint, called femur or thigh bone, with the lower leg bone, called the tibia or shin bone. These cruciate ligaments along with others function to retain knee stability, mobility and strength.

Who is at risk for an ACL injury?

Injuries to the ACL are among the most common type of knee injury, especially among athletes in sports that place significant demands on the knee. Recent injury data suggests that ACL injuries are increasing at alarming rates among adolescents and young adults who engage in sports that requires jumping, cutting and pivoting. Rates are higher among female athletes versus male athletes in similar sports. Sports that increase the risk of damage to the ACL include tennis, soccer, baseball, basketball, skiing, snowboarding and gymnastics.

A torn ACL causes knee instability during activity and is one of the most common knee injuries. Instability can also damage the meniscus.

Grading of ACL injuries

ACL injuries are graded based on their severity.

• Grade 1 is the mildest injuries, where the ligament is stretched, but not enough to cause significant instability.
• Grade 2 injuries include partial tears and more substantial stretching that causes instability in the joint.
• Grade 3 injuries cause the ligament to become completely torn, resulting in significant instability in the joint. Many ACL injuries fall into this category.

Grade 1 ACL injuries may be treated with a knee brace and crutches along with physical therapy to restore range of motion and strength in the muscles that support the joint. However, most ACL injuries are not able to be repaired or reattached. Rather the ligament must be replaced during surgery to prevent instability and future injury, and damage to other parts of the knee.

When is ACL reconstruction performed?

An unstable knee increases the risk of damage to other parts of the knee. ACL reconstruction will be recommended to restore knee stability and treat knee pain, to enable return to sports and daily activities, and when other ligaments are also injured and/or when the meniscus is also torn. Young and active patients who desire to continue to play demanding or competitive sports are candidates for ACL reconstruction surgery.

Some older individuals with low activity levels with a damaged ACL may be able to participate in pre-operative rehabilitation (Pre-Hab) and find that they can return to the activities the love without surgery.  However, most people with an active lifestyle will find that surgery is the best way to return to their prior level of activity.

What is ACL reconstruction?

ACL reconstruction surgery is minimally invasive arthroscopic surgery performed under regional or general anesthesia. Minimally invasive arthroscopic surgery offers many benefits including tiny incisions, less damage to surrounding tissues, less blood loss, less pain and faster healing.

It is surgery to rebuild the torn ligament to restore function and prevent future injuries. During surgery, the torn ligament is removed and replaced with a graft using a ligament or tendon taken from another part of the body. In some cases, the graft may be donated by an organ donor. The graft is held in place with screws. Incisions are closed with staples or stitches.

Patients go home the same day, wearing a knee brace, and using crutches. The brace may be worn for a prescribed period of one to four weeks. Medication will be prescribed to control pain. Physical therapy for 4 – 6 months is designed to assist in regaining knee motion and strength. When the patient desires to return to sports, it may take 9-12 months of rehabilitation.

The goal is to eliminate pain and dysfunction and restore full active range of motion. Rehabilitation will reduce pain and stiffness after surgery and provide for quicker recovery.

Pre-Surgical rehabilitation

Most patients will not receive ACL reconstruction immediately after injury unless there is other serious knee damage. Instead, presurgical rehabilitation is recommended to reduce inflammation and restore range of motion and the function of the quadriceps before surgery. Studies have shown that presurgical rehabilitation is beneficial to reduce stiffness after surgery a common surgical complication.

Dr. Tom Hackett is a highly respected, board-certified orthopedic surgeon at the prestigious Steadman Clinic in Vail Colorado. Dr. Hackett is an expert in the surgical and nonsurgical treatment of the knee; and a specialist in arthroscopic surgical procedures. Contact Dr. Hackett to schedule a consultation.