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ACL Knee Reconstruction and Arthroscopic Repair Surgery for Torn ACLWhat is the ACL?Clink link below to find out The anterior cruciate ligament (ACL) is a major stabilizing knee ligament. It is a tough, non-stretchable rope-like structure that connects the thighbone (femur) to the leg bone (tibia).
There are two cruciate ligaments that crisscross in the knee joint. The ACL attaches “anterior” (in front) to the posterior cruciate ligament (PCL). The ACL is more commonly injured than the PCL, and ACL tears more commonly require surgery. Although the surgery is often referred to as an ACL repair it is more appropriately called and ACL reconstruction (see below). How an ACL Tears OccurPatients often tear the ACL by changing direction rapidly (e.g. cutting or pivoting), slowing down from running and twisting with one foot planted or hyper-extending the knee when landing from a jump. It is less common to have a direct injury to the knee where another person or object lands on the knee causing the ACL to tear. Most patients will report hearing a knee pop when their ACL tears.As the tear occurs, the knee usually gives out and fills with fluid and blood. This immediate swelling within first 6 to 12 hours after injury is another hallmark of ACL tears.
The combination of the ACL tear and the swelling causes patients to feel pain. Patients are unable to continue their activity when the injury occurs. Most will limp for several days if not longer. At that point the swelling usually decreases and the knee begins to feel better. In some cases people won’t even visit a doctor because they think it is a sprain that is healing. Unfortunately if they try to run, jump or pivot the knee will give-way again causing more injury in some cases. It is important to understand that every patient does not experience each of these symptoms. Some report very little swelling or pain while others cannot straighten or bend their knee for weeks. Initial Treatment for ACL TearsAlthough you may not know that you have torn your ACL, if you do experience a significant knee injury with swelling you should follow the R.I.C.E. program. This treatment includes Rest, Ice, Compression and Elevation (RICE). Swelling occurs because the torn ACL causes bleeding within the knee. The knee joint will slowly absorb the blood and the swelling will usually decrease if RICE is followed.
ACL Surgical Evaluation- Repairing the torn ACL with SurgeryA thorough evaluation by an orthopedic surgeon who specializes in knee ligament injuries is needed as soon as possible after injury. As the ACL tears and the knee slides out of place, other structures within the knee are often injured. These other structures include the medial meniscus, lateral meniscus as well as cartilage. In some severe knee injuries additional ligaments can also be sprained or torn. The other common knee ligaments are the MCL (medial collateral ligament), PCL (posterior cruciate ligament) and LCL (lateral collateral ligament). Your surgeon will examine your knee and order x-rays. Most injuries can be diagnosed without an MRI. However, if there is any uncertainty, an MRI can be ordered. You will also be encouraged to continue icing your knee and start moving it to help prevent stiffness. In some cases you will be sent to physical therapy before surgery to regain knee motion and strength. ACL Repair and ACL SurgeryGo Ortho ACL Repair Fact Sheet Most patients need ACL surgery to restore full knee function allowing them to safely resume all activities. Since the ACL unravels like a braided rope, it cannot be simply sewn back together. This type of ACL repair was tried in the 1960’s and did not work. Today's successful ACL surgeries involve replacing the ligament with strong, healthy tissue taken from another area near your knee or from a cadaver donor. A strip of tendon from under your kneecap (patellar tendon), your hamstring tendons, or donor tissue may be used. The tissue is referred to as a graft. If it is from your body it is called an autograft. If from a cadaver then it is referred to as an allograft. The Patellar tendon, also known as bone-patellar tendon-bone autografts and hamstring tendon autografts, are the most common autografts used. Quadriceps tendon autografts are used by some surgeons but it is less common. A variety of allograft tissues can be used including: tibialis tendon, Achilles tendon, patellar tendon, hamstring tendon and fascia latta tendon. Autograft and allograft Tendons for ACL RepairI have extensive experience with using patellar tendon, hamstring tendon, and most of the cadaver donor (allograft) tissues for reconstruction of the anterior cruciate ligament. In most cases, my preference is The patellar tendon is often used in younger, high level athletes because it permits the most aggressive rehabilitation after surgery. The biggest downside of patellar tendon is that about 20-30% of patients experience some kneecap-related discomfort with kneeling or squatting after surgery. Although 20-30% is the common reported rate for post-op kneecap pain, it is an uncommon complaint from my patients.
Hamstring tendons are also used commonly by many surgeons. I do not however see any advantage in using hamstring tendons over donor tissue. In most cases, my preference is to use donor tissue so patients don't have to endure the additional surgery required to take tissue from another area of their knee. However, regardless of the source of the new ACL tissue, more than 90% of patients continue to do well 5-10 years after surgery. The ACL surgery is performed with the assistance of a small fiber optic camera called an arthroscope, which permits me to see the entire knee joint. If there are other injuries such as cartilage or meniscus tears, I will repair those first. Next, I create small sockets in the two bones (femur & tibia) where the ACL normally attaches. The new ACL graft tissue is then placed into these sockets and usually secured with absorbable screws. The latest all-inside ACL surgery technique allows me to perform the entire surgery arthroscopically without any large incisions. The only time an incision is needed is if you want autograft tissue. This requires a cut in order for me to take this tissue. Why Putting Off ACL Surgery Is Not Always a Good IdeaLess active people may be treated non surgically with a program of muscle strengthening. However, almost most healthy, active patients should have surgery to restore full knee function. Three decades ago, patients over age 40 were often told they were too old to have surgery. Unfortunately, there are still some 'old school' doctors telling patients the same thing even today. However. for those of us who are better educated, we now place no age restrictions on surgery.
Factors such as activity level and lifestyle are much more important than age. It is important to note that if the ACL is not reconstructed, most active patients will experience repeat episodes of their knee 'giving-way'. Each time this happens, other structures such as cartilage and menisci can be damaged, leading to early arthritis. Since the term 'active' can mean many different things to different people, let me define it better. In terms of risk of your knee giving way after the ACL is torn, those people that participate in activities that require twisting, jumping, cutting and pivoting are at greatest risk of further injury. In most cases, a brace will not Successful ACL reconstruction surgery tightens your knee and restores its stability. It also helps you avoid further injury and get back to playing sports. In the U.S., doctors see more than 200,000 ACL tears each year. When patients are evaluated 5 to 10 years after surgery, there is an 85 to 95 percent success rate. How Long Before I can Return to Sports?
After ACL reconstruction, exercises are needed to gradually return your knee to full flexibility and strength. Building strength in your thigh and calf muscles is important in supporting the reconstructed knee. A physical therapist will guide you through a specific rehab program that focuses on return to full activities. An individualized rehab program tailored to each patient’s progress in essential. Some patients return to sports as early as four months after injury, but typically it takes six to nine months for most people. It is difficult to give you a “cookbook” type of rehabilitation program. Every injury and every patient is different. It is important for the surgeon and physical therapist to understand this and for them to communicate with each other regarding the patients’ progress. About the Author, Orthopedic Surgeon and Arthroscopic ACL Knee Surgeon SpecialistDr. Vic Goradia performs several hundred arthroscopic surgeries each year with most of these being knee and shoulder arthroscopic surgery. Since 1994, Dr. Goradia has had a special interest in ACL tears and ACL surgery. This prompted Dr. Goradia to conduct many research studies that have received awards from national orthopedic and sports medicine societies. He has also lectured extensively on the subject. Currently his major interest is in teaching the latest all-inside ACL Surgery to other surgeons around the U.S. Dr. Goradia is considered a Top ACL Surgeon and Top Knee Surgeon in Richmond, in Virginia and even in the U.S. For more information about Dr. Goradia visit our home page, goortho.net |
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