ACL Reconstruction
What is ACL Reconstruction?
Anterior cruciate ligament (ACL) reconstruction is a surgical procedure to replace a torn or damaged ACL ligament in your knee with a new ACL tissue graft obtained most commonly from your own body (autograft) or in rare cases from a deceased donor (allograft).
The most common autografts are the patellar tendon (tendon of the kneecap) or one of the hamstring tendons (tendons located at the back of the thigh). In some instances, the quadriceps tendon located above the kneecap is utilized. Tendons are cords of strong fibrous tissue that connect muscles to bones. Ligaments are tough bands of tissue that connect one bone to another bone.
ACL tears or injuries most often occur during sports activities that involve pivoting, cutting, and turning movements as in football, soccer, skiing, tennis, and basketball.
Anatomy of the ACL
The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope-like structure located in the center of the knee, running from the femur (thighbone) to the tibia (shinbone). The ACL is one of the four major ligaments of the knee that connects the femur to the tibia and helps stabilize your knee joint. It prevents excessive forward movement of the tibia in relation to the femur as well as limits rotational movements of the knee. When this ligament tears, unfortunately, it does not heal on its own and often leads to the feeling of instability in the knee, requiring reconstruction to correct the abnormality.
Indications for ACL Reconstruction
An ACL tear or injury is the main indication for ACL reconstruction surgery. An ACL injury is a sports-related injury that occurs when the knee is forcefully twisted or hyper-extended. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down suddenly while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also result in injury to the ACL.
Preparation for ACL Reconstruction
In general, preparation for ACL reconstruction surgery will involve the following steps:
- A review of your medical history and physical examination are performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
- You may be asked to stop taking certain medications, such as blood thinners, anti-inflammatories, aspirin, or other supplements for a week or two.
- You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after, as it can hinder the healing process.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You should arrange for someone to drive you home after surgery.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.
Procedure for ACL Reconstruction
ACL reconstruction surgery is usually performed under general anesthesia in a minimally invasive arthroscopic technique. In general, the procedure involves the following steps:
- Your surgeon will make two to three small cuts, about 1/4-inch-long, around your knee.
- An arthroscope is inserted into the knee joint through one of the incisions.
- An arthroscope is a thin tubular instrument with a camera, light, and a magnifying lens attached at the end that is connected to an external monitor and enables your surgeon to view the inside of the knee joint.
- Along with the arthroscope, a sterile solution is pumped into the joint to expand it, enabling your surgeon to have a clear view and space to work inside the joint.
- Miniature surgical instruments are passed through the other incisions and the torn ACL is removed and the pathway for the new ACL tendon graft is prepared.
- Your surgeon makes an incision over the knee or hamstring area and takes out a part of the patellar, hamstring, or quadriceps tendon to prepare the new ACL graft.
- Small holes are drilled into the upper and lower leg bones (femur and tibia) where these bones come together at the knee joint. The holes form tunnels in your bone to accept the new graft.
- The graft is pulled through the predrilled holes in the femur and tibia and fixed into the bones with screws or suture anchors.
- After confirming satisfactory reconstruction, the scope and the instruments are withdrawn, and the incisions are sutured and bandaged.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after ACL reconstruction surgery will involve the following:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic or anesthetic reactions and monitor your vital signs as you recover.
- You may notice pain, swelling, and discomfort in the knee area. Pain and anti-inflammatory medications are provided as needed to keep you comfortable.
- You are advised to keep your leg elevated while resting to prevent swelling and pain.
- You will be given assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
- Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
- Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. A gradual increase in activities is recommended.
- An individualized physical therapy protocol will be designed to help strengthen the knee muscles and optimize knee function.
- You will be able to resume your normal daily activities in a couple of months, but with certain activity restrictions. Full recovery and return to sports usually take about 9 to 12 months.
- You may return to your work in about 6 weeks if your job is not too physically demanding. Those with physically demanding jobs will require a longer recovery period.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
ACL reconstruction surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Infection
- Bleeding
- Pain and weakness in the knee
- Adverse reactions to anesthesia
- Blood clot or deep vein thrombosis
- Damage to adjacent soft tissue structures
- Stiffness or decreased range of motion
- Re-rupture of the graft
- Non-healing of the ligament
Failed Anterior Cruciate Ligament (ACL) Reconstruction
Knee Joint
The knee joint is stabilized by four strong ligaments. The anterior cruciate ligament (ACL) passes diagonally in the middle of the knee, ensuring that the thigh and shin bone do not slide out of alignment during movement. ACL injury is one of the most common sports injuries of the knee joint and is generally repaired with ACL reconstruction surgery, where the torn ligament is replaced with a graft tendon. While this process is a very common and highly successful procedure, some may fail to achieve stability.
Failed ACL Reconstruction
Anterior cruciate ligament reconstruction failure may be due to the following problems:
Technical: This is the most common cause of failure and may involve incorrect drilling of a tunnel through the tibial or femoral bone for the attachment of the graft. This may cause increased stress on the graft or rubbing (impingement) of the graft on the surrounding edges of the bone. Other technical problems may include improper harvesting of the graft from the donor site, graft tensioning or inadequate graft fixation.
Biologic: This may be due to infection or graft rejection. Infection can be treated with irrigation and removal of damaged tissue of the joint as well as intravenous antibiotics.
Traumatic: This may occur due to early return to full activity, aggressive rehabilitation, trauma or non-compliance with activity restriction during the post-operative period.
Associated ligament laxity: Laxity of the other ligaments that support the knee has to be addressed either before or during the anterior cruciate ligament reconstruction to prevent undue stress on the reconstruction, and resultant failure.
Arthrofibrosis: Decreased post-operative range of motion of the knee called arthrofibrosis due to prolonged postoperative immobilization may be a cause for failed reconstruction.
A revision ACL reconstruction is considered after determining the exact cause for the initial failure. Repeat surgery is performed to improve graft stability and address other comorbidities such as infection and arthrofibrosis. Various alternative techniques, fixatives, and grafts are carefully considered for the revision reconstruction to correct failures of the primary surgery.
ACL Reconstruction Patellar Tendon
ACL Reconstruction Surgeon in <_____LOCATION_____>
ACL injuries occur mostly during sports activities. The injured or torn ACL can be reconstructed by replacing the damaged portion with a part of the patellar tendon taken from the leg. <_____NAME_____> provides diagnosis and minimally-invasive ACL reconstruction using patellar tendon in <_____LOCATION_____>. <_____NAME_____> also provides the highest level of care during and after the surgery. Contact <_____NAME_____>’s office for an appointment today!
What is ACL Reconstruction with Patellar Tendon?
Anterior cruciate ligament (ACL) reconstruction with patellar tendon is a surgical procedure that replaces the injured ACL with a patellar tendon. The goal of ACL reconstruction surgery is to tighten your knee and to restore its stability.
ACL Anatomy
The anterior cruciate ligament is one of the four major ligaments of the knee that connects the femur (thighbone) to the tibia (shinbone) and helps stabilize the knee joint. The anterior cruciate ligament prevents excessive forward movement of the lower leg bone (tibia) in relation to the thighbone (femur) as well as limits rotational movements of the knee.
ACL Injuries
A tear of this ligament can make you feel as though your knees will not allow you to move or even hold you up. Anterior cruciate ligament reconstruction is surgery to reconstruct the torn ligament of your knee with a tissue graft.
Causes of an ACL Injury
An ACL injury most commonly occurs during sports activities that involve twisting or overextending your knee. An ACL can be injured in several ways:
- Sudden directional change
- Slowing down while running
- Landing from a jump incorrectly
- Direct blow to the side of your knee, such as during a football tackle
Symptoms of an ACL Injury
When you injure your ACL, you might hear a loud "pop" sound and may feel the knee buckle. Within a few hours after an ACL injury, your knee may swell due to bleeding within the torn ligament. You may notice that the knee feels unstable or seems to give way, especially when trying to change direction.
Diagnosis of an ACL Injury
An ACL injury can be diagnosed with a thorough physical examination of the knee and diagnostic tests such as X-rays (to rule out fractures), MRI scans and arthroscopy. In addition, your surgeon will often perform the Lachman’s test to see if the ACL is intact. During a Lachman test, the knee with a torn ACL may show increased forward movement of the tibia and a soft or mushy endpoint compared to a healthy knee.
The pivot shift test is another test to assess ACL tears. During this test, if the ACL is torn, the tibia will move forward when the knee is completely straight and as the knee bends past 30° the tibia shifts back into correct place in relation to the femur.
Procedure for ACL Reconstruction with Patellar Tendon
Anterior cruciate ligament reconstruction patellar tendon is a surgical procedure to replace the torn ACL with part of the patellar tendon taken from your leg. The new ACL is harvested from the patellar tendon that connects the bottom of the kneecap (patella) to the top of the shinbone (tibia). The procedure is performed under general anesthesia.
Your surgeon will make two small cuts about ¼ inch around your knee. An arthroscope, a tube with a small video camera on the end is inserted through one incision to see the inside of the knee joint. Along with the arthroscope, a sterile solution is pumped into the knee to expand it, providing your surgeon with a clear view of the inside of the joint.
The torn ACL will be removed and the pathway for the new ACL is prepared. Your surgeon makes an incision over the patellar tendon and removes the middle third of the patellar tendon, along with small plugs of bone where it is attached on each end. The remaining portions of the patellar tendon on either side of the graft are sutured back after its removal. Then the incision is closed.
The arthroscope is reinserted into the knee joint through one of the small incisions. Small holes are drilled into the upper and lower leg bones (tibia and femur) where these bones come together at the knee joint. The holes form tunnels in your bone to accept the new graft. The graft is then pulled through these holes. The new tendon is then fixed into the bone with screws to hold it in place while the ligament heals into the bone.
The incisions are then closed with sutures and a dressing is placed.
Postoperative Care following ACL Reconstruction with Patellar Tendon
Following the surgery, rehabilitation begins immediately. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement. Avoid competitive sports for 5 to 6 months to allow the new graft to get incorporated into the knee joint.
Anterior cruciate ligament reconstruction is a very common and successful procedure. It is usually indicated in patients who desire to return to an active lifestyle, especially into sports that involve running and twisting. Anterior cruciate ligament injury is a common knee ligament injury. If you have injured your anterior cruciate ligament, surgery may be needed to regain full function of your knee.
Risks and Complications of ACL Reconstruction with Patellar Tendon
The possible risks and complications associated with ACL reconstruction with the patellar tendon method include:
- Numbness
- Infection
- Blood clots (deep vein thrombosis)
- Nerve and blood vessel damage
- Failure of the graft
- Loosening of the graft
- Decreased range of motion
- Crepitus (crackling or grating feeling of the kneecap)
- Pain in the knee
- Recurrence of injury to the graft
If you would like to have additional information on the treatment of ACL injury or would like to learn more about ACL reconstruction with patellar tendon, please contact <_____NAME_____>, serving the communities of <_____LOCATION_____>.
ACL Reconstruction With Hamstring Tendon
ACL Reconstruction Surgeon in <_____LOCATION_____>
ACL reconstruction with hamstring tendon is a surgical procedure to replace the torn ACL with part of the hamstring tendon taken from the back of the thigh. <_____NAME_____> provides diagnosis and minimally invasive ACL reconstruction with hamstring tendon in <_____LOCATION_____>. <_____NAME_____> also provides the highest level of care during and after the surgery. Contact <_____NAME_____>’s office for an appointment today!
What is ACL Reconstruction With Hamstring Tendon?
Anterior cruciate ligament (ACL) reconstruction with hamstring tendon is a surgical procedure to replace the torn ACL with part of the hamstring tendon taken from your leg. The hamstring is the muscle located on the back of your thigh. The goal of ACL reconstruction surgery is to tighten your knee and restore its stability.
Anterior Cruciate Ligament Tears
The anterior cruciate ligament (ACL) is one of the major stabilizing ligaments in the knee. It is a strong rope-like structure located in the center of the knee running from the femur to the tibia. When this ligament tears, it does not heal on its own and often leads to the feeling of instability in the knee.
Causes of an ACL Injury
An ACL injury most commonly occurs during sports activities that involve twisting or overextending your knee. An ACL can be injured in several ways:
- Sudden directional change
- Slowing down while running
- Landing from a jump incorrectly
- Direct blow to the side of your knee, such as during a football tackle
Symptoms of an ACL Injury
When you injure your ACL, you might hear a loud "pop" sound and may feel the knee buckle. Within a few hours after an ACL injury, your knee may swell due to bleeding within the torn ligament. You may notice that the knee feels unstable or seems to give way, especially when trying to change direction.
Diagnosis of an ACL Injury
An ACL injury can be diagnosed with a thorough physical examination of the knee and diagnostic tests such as X-rays (to rule out fractures), MRI scans and arthroscopy. In addition, your surgeon will often perform the Lachman’s test to see if the ACL is intact. During a Lachman test, the knee with a torn ACL may show increased forward movement of the tibia and a soft or mushy endpoint compared to a healthy knee.
The pivot shift test is another test to assess ACL tears. During this test, if the ACL is torn, the tibia will move forward when the knee is completely straight and as the knee bends past 30° the tibia shifts back into correct place in relation to the femur.
Procedure
The procedure is performed under general anesthesia. Your surgeon will make two small incisions about 1/4-inch-long around your knee. An arthroscope, a tube with a small video camera on the end is inserted through one incision to view the inside of the knee joint. Along with the arthroscope, a sterile solution is pumped into the joint to expand it, enabling your surgeon to have a clear view and space to work inside the joint.
The knee is bent at right angles and the hamstring tendons felt. A small incision is made where the hamstring tendon attaches to the tibia. The two tendons are stripped off the muscle and the graft is prepared.
The torn ACL will be removed and the pathway for the new ACL prepared. The arthroscope is reinserted into the knee joint through one of the small incisions. Small holes are drilled into the upper and lower leg bones (tibia and femur) where these bones come together at the knee joint. The holes form tunnels in your bone to accept the new graft. The graft is pulled through these holes. The new tendon is then fixed into the bone with screws to hold it into place while the ligament heals into the bone.
The incisions are then closed with sutures and a dressing is placed.
Postoperative Care Following ACL Reconstruction With Hamstring Tendon
Following the surgery, rehabilitation begins immediately. A physical therapist will teach you specific exercises to be performed to strengthen your leg and restore knee movement. Avoid competitive sports for 5 to 6 months to allow the new graft to incorporate into the knee joint.
Risks and Complications of ACL Reconstruction With Hamstring Tendon
The possible risks and complications associated with ACL reconstruction with hamstring tendon include:
- Numbness
- Infection
- Blood clots (deep vein thrombosis)
- Nerve and blood vessel damage
- Failure of the graft
- Loosening of the graft
- Decreased range of motion
- Crepitus (crackling or grating feeling of the kneecap)
- Pain in the knee
- Repeat injury to the graft
If you would like to have additional information on the treatment of ACL injury or would like to learn more about ACL reconstruction with hamstring tendon, please contact <_____NAME_____>, serving the communities of <_____LOCATION_____>.
ACL Tears
What is the ACL?
The anterior cruciate ligament (ACL) is one of the major ligaments of the knee. It is located in the middle of the knee and runs from the femur (thighbone) to the tibia (shinbone). The ACL prevents the tibia from sliding out in front of the femur. Together with the posterior cruciate ligament (PCL), it provides rotational stability to the knee.
Causes of ACL Tears
An ACL injury is a sports-related injury that occurs when the knee is forcefully twisted or hyperextended. An ACL tear usually occurs with an abrupt directional change when the foot is fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also cause injury to the ACL.
Symptoms of ACL Tears
When you injure your ACL, you may hear a pop sound and may feel as though the knee has given way. Within the first two hours after injury, your knee will swell and you may have a buckling sensation in the knee during twisting movements.
Diagnosis of ACL Tears
The diagnosis of an ACL tear is made by reviewing your symptoms and medical history and performing a physical examination of the knee. Other diagnostic tests such as X-rays, MRI scans, stress tests of the ligament and arthroscopy may also be ordered.
Treatment of ACL Tears
Treatment options include both non-surgical and surgical methods. If the overall stability of the knee is intact, your doctor may recommend non-surgical methods. Non-surgical treatment consists of rest, ice, compression and elevation (RICE protocol); all of these assists in controlling pain and swelling. Physical therapy may be recommended to improve knee motion and strength. A knee brace may be needed to help immobilize your knee.
Young athletes involved in pivoting sports will most likely require surgery to safely return to sports. The usual surgery for an ACL tear is an ACL reconstruction which tightens your knee and restores its stability. Surgery to reconstruct an ACL is performed with an arthroscope, using small incisions. During the surgery, your doctor will replace the torn ligament with a tissue graft that can be obtained from your knee (patellar tendon) or hamstring muscle.
Following ACL reconstruction, a rehabilitation program is started to help you resume a wider range of activities.
Failed Anterior Cruciate Ligament (ACL) Reconstruction
Knee Joint
The knee joint is stabilized by four strong ligaments. The anterior cruciate ligament (ACL) passes diagonally in the middle of the knee, ensuring that the thigh and shin bone do not slide out of alignment during movement. ACL injury is one of the most common sports injuries of the knee joint and is generally repaired with ACL reconstruction surgery, where the torn ligament is replaced with a graft tendon. While this process is a very common and highly successful procedure, some may fail to achieve stability.
Failed ACL Reconstruction
Anterior cruciate ligament reconstruction failure may be due to the following problems:
Technical: This is the most common cause of failure and may involve incorrect drilling of a tunnel through the tibial or femoral bone for the attachment of the graft. This may cause increased stress on the graft or rubbing (impingement) of the graft on the surrounding edges of the bone. Other technical problems may include improper harvesting of the graft from the donor site, graft tensioning or inadequate graft fixation.
Biologic: This may be due to infection or graft rejection. Infection can be treated with irrigation and removal of damaged tissue of the joint as well as intravenous antibiotics.
Traumatic: This may occur due to early return to full activity, aggressive rehabilitation, trauma or non-compliance with activity restriction during the post-operative period.
Associated ligament laxity: Laxity of the other ligaments that support the knee has to be addressed either before or during the anterior cruciate ligament reconstruction to prevent undue stress on the reconstruction, and resultant failure.
Arthrofibrosis: Decreased post-operative range of motion of the knee called arthrofibrosis due to prolonged postoperative immobilization may be a cause for failed reconstruction.
A revision ACL reconstruction is considered after determining the exact cause for the initial failure. Repeat surgery is performed to improve graft stability and address other comorbidities such as infection and arthrofibrosis. Various alternative techniques, fixatives, and grafts are carefully considered for the revision reconstruction to correct failures of the primary surgery.
Women and ACL Injuries
Anterior Cruciate Ligament (ACL) Injuries
The anterior cruciate ligament is one of the four major ligaments of the knee that connects the femur (thigh bone) to the tibia (shin bone) and helps stabilize the knee joint. Anterior cruciate ligament (ACL) injury is one of the common injuries of the knee. An injury to the ACL commonly occurs during sports or activities that involve twisting, overextension, landing from a jump incorrectly and abrupt change in direction or speed of movements.
ACL Injuries in Women
ACL injuries are more common in women than men due to anatomical differences which include:
- Women have a smaller ACL, a wider pelvis and an increased incidence of inward knee pointing.
- Women have less strength in the muscles as compared to men. In addition, women use their quadriceps muscles more than men for stability and take more time to develop muscular force resulting in greater stress on the ACL.
- Women have looser knees and a greater range of motion as compared to men.
These factors make women more vulnerable to ACL injury by weakening the ligament.
A training and rehabilitation program can help reduce the risk of ACL injury. The program focuses on:
- Controlling inward knee movement.
- Emphasizing the use of the hamstring muscles for knee stability.
- Controlling the movement of the hip and trunk and training the hip muscles to stabilize the knee.
- Controlling knee extension.
- Increasing muscle endurance.
