ACL Reconstruction Surgery

When Do You Need ACL Reconstruction Surgery?

The knee joint is crucial for movement, supporting our weight and enabling activities like walking, running, and bending. However, injuries can significantly impact its function, with damage to the anterior cruciate ligament (ACL) being one of the most common and serious. When an ACL injury occurs, surgical reconstruction may be necessary to restore stability and function to the knee.

Anatomy

What Is the ACL (Anterior Cruciate Ligament)?

The ACL is one of the four major ligaments that maintain proper alignment and functionality of the knee. This ligament specifically connects the thighbone (femur) to the shinbone (tibia) to prevent the shinbone from sliding too far forward under the thighbone. It is vital for activities that involve sudden stops, changes in direction, and pivoting movements. This makes ACL injuries common especially among athletes.

What Are the Different ACL Injuries?

Injured ligaments are considered sprains. They are graded based on how severe an ACL tear is:

• Grade 1: The ACL is mildly damaged as it has been slightly stretched. However, the ligament can still keep the knee joint stable.
• Grade 2 (Partial Tear): The sprain stretches the ACL to the point where it becomes loose. The ligament cannot provide full stability to the joint.
• Grade 3 (Complete Tear): The ACL has been torn in half or pulled directly off the bone. It causes significant instability in the knee joint.

What Is ACL Reconstruction Surgery?

ACL reconstruction surgery replaces the torn ligament with a graft. This graft restores knee stability, allowing for more normal function and enabling patients to return to their desired level of activity, whether it is sports, exercise, or simply enjoying daily life.

When Should ACL Surgery Be Considered?

Unlike some tissues in the body, the ACL has a limited blood supply, which hinders the healing process of the ligament. Without enough blood flow, the torn ligament ends cannot heal, causing the knee joint to remain unstable. To restore the stability of the knee joint, the torn ACL requires reconstruction surgery.

ACL surgery is often recommended in the following situations:

• Complete ACL Tear – Unlike partial tears, complete tears do not heal on their own. Surgery is generally recommended for people with complete ACL tear to rebuild the ligament and restore stability to the joint.
• Severe Instability – This sudden feeling of knee buckling or giving out can significantly impact daily activities. Severe instability increases the risk of further injury, making surgical intervention crucial.
• Loss of Full Range of Motion – Difficulty in fully straightening or bending the knee after an ACL injury suggests damage beyond the injury, which may necessitate surgery.
• Active Lifestyle – Athletes or individuals involved in high-demand physical activities, especially those requiring pivoting, jumping, or sudden directional changes, are often advised to undergo surgery to regain full knee strength and prevent repeated injuries.
• Failure of Conservative Treatments – If physiotherapy, bracing, and other non-surgical treatments fail to restore knee stability and function, surgical reconstruction becomes the next logical step.

What Are the Types of ACL Reconstruction Surgery?

ACL reconstruction surgery involves replacing the torn ligament with a graft. The choice of graft material significantly impacts the surgical outcome. Here are the primary types:

• Autograft This utilises tissue harvested from the patient's own body. Common sources include tendons from the hamstring, patellar, or quadriceps.
• Allograft This involves using tissue from a deceased donor. While convenient, allografts may have a slightly higher risk of complications compared to autografts.
• Synthetic Grafts These utilise artificial materials such as carbon fibre or polyethylene. They offer an alternative for patients unsuitable for autografts or allografts, such as those with limited tissue availability or contraindications to donor tissue.

The choice of graft material is a crucial decision made in consultation with the knee surgeon, considering factors such as the patient's age, activity level, and overall health.

How to Prepare for ACL Reconstruction

Proper preparation before ACL reconstruction surgery is crucial to ensure the best possible outcome. This may generally involve:

• Medication Adjustment – Inform your doctor about all medications and follow guidance on adjustments to avoid complications.
• Smoking Cessation – Quit smoking to improve healing and reduce surgical risks.
• Maintaining a Healthy Weight – Maintain a balanced diet and regular exercise to support recovery.
• Rest and Stress Management – Get adequate sleep and manage stress for better recovery outcomes.
• Hydration – Stay well-hydrated to support your body during surgery and recovery.

How Is ACL Reconstruction Surgery Performed?

ACL reconstruction surgery is typically performed via arthroscopic techniques as follows:

• Anaesthesia: The patient is administered anaesthesia, which can include general anaesthesia (putting the patient to sleep) or regional anaesthesia (numbing the lower body).
• Incisions: Small incisions are made around the knee joint.
• Arthroscopic Access: An arthroscope, a thin, lighted instrument with a camera, is inserted through one incision. This allows the surgeon to visualise the inside of the knee joint on a monitor.
• Graft Harvesting (if autograft): If an autograft is used, the surgeon harvests the graft material from another part of the patient's body.
• ACL Removal: The torn portions of the ACL are carefully removed.
• Tunnel Creation: Tunnels are drilled into the femur (thighbone) and tibia (shinbone), the bones where the ACL normally attaches.
• Graft Placement: The graft material is carefully threaded through the tunnels, recreating the path of the original ACL.
• Graft Fixation: The graft is secured in place using specialised techniques such as screws, buttons, or other fixation devices.
• Closure: The incisions are then closed with sutures, and a bandage is applied to protect the surgical site.

What Happens After the Procedure?

Most patients can go home the same day. However, they may need to stay in the recovery room for at least two hours to allow the effects of anaesthesia to wear off. In some cases, patients may need to stay in the hospital overnight.

Pain medications will be prescribed to manage post-operative discomfort. The surgeon will also provide instructions on using crutches and applying ice to the knee to aid in the recovery process.

Proper rehabilitation plays a crucial role in the success of ACL reconstruction. Patients may begin walking with the assistance of crutches and a knee brace for support and stability. Physiotherapy will commence within the first few days or weeks after surgery to restore strength, stability, and range of motion to the knee. Regular follow-up appointments with the surgeon are essential to monitor progress, adjust rehabilitation plans, and ensure optimal recovery.

What Are the Risks of ACL Reconstruction Surgery?

ACL reconstruction surgery is generally safe and effective in the hands of an experienced surgeon. However, as with any surgical procedure, it still carries small risks, including:

• Bleeding
• Blood clots
• Continued knee pain
• Infection
• Improper healing if the graft is rejected by the immune system
• Allergic reaction to the equipment, materials, or medication

FAQs About ACL Reconstruction Surgery

How soon can you recover after undergoing ACL reconstruction surgery?

 

Patients typically regain a significant range of motion in their knees within weeks. However, a full return to sports usually takes 6 to 12 months. Recovery involves diligent physiotherapy to restore strength, stability, and range of motion, along with close monitoring by the surgeon to ensure optimal recovery.

Can young athletes or teenagers undergo ACL surgery?

Yes, young athletes or teenagers can undergo ACL surgery but might not be able to have the same ACL surgery as adults due to the presence of growth plates. For more personalised advice, it is always best to consult a knee surgeon.