ACL RECONSTRUCTION

KNEE TOPICS

*These pages are for informational purposes only and are not intended as medical advice. Please consult a physician for specific diagnosis and treatment options.*

The anterior cruciate ligament (ACL) is the most commonly torn ligament in the knee. The major cause of ACL injuries is sports because of the twisting and cutting maneuvers commonly associated with these activities. The ACL can also be torn because of work injuries or accidents.

SYMPTOMS

Symptoms of ACL tears vary from person to person depending on the degree of injury. Some people hear a loud "popping" or "snap" at the time of injury. Some experience pain and swelling. Most people feel apprehension or hesitancy to walk on the affected leg because of the loss of stability they feel.

DIAGNOSIS

Diagnosis of your ACL injury is determined by history and examination. Understanding how you injured your knee and the symptoms you have experienced are helpful in determining the extent of your injury. The physical examination is very important in reaching a diagnosis. Assessing the motion in your knee is an important diagnostic tool in evaluating ACL injury. In addition, because of the close approximation of other structures to the ACL, these structures will also be checked to rule out any problems. Your doctor may take xrays of your knee to determine if any fractures were sustained. Ligaments and tendons are not visible on xray. If history and examination are inconclusive in determining an ACL tear, or the severity of an ACL tear, an MRI may be ordered. An MRI can also evaluate cartilage damage within the knee.

TREATMENT

Treatment for ACL injuries is based on the extent of injury, a patient's age and how much demand is placed on a person's knee joint based on their lifestyle. A more physically active person may require surgery to help prevent any further injury to the joint. It is important to understand that the instability created from an ACL injury may eventually lead to further damage to other structures in your knee and could lead to long term problems such as arthritis.

Non-surgical treatment may include icing the knee joint to help reduce swelling that has occurred in the initial stages of injury. Using a brace and/or crutches allows your joint to rest to help it to heal. Physical therapy may be ordered to help you gain strength in your leg muscles to help compensate for your injured ligament.

Surgical treatment for ACL tears often involves replacing the torn knee ligament with a new tendon. The surgery is known as an ACL Reconstruction. The new tendon used (also known as the graft) is usually the patellar tendon or a hamstring tendon graft. Which tendon is used is typically based on doctor's preference. The tendon is taken from the same leg and an incision is required. All other work related to your surgery is done arthroscopically (through puncture hole type incisions). Through the arthroscope, your physician will first look at your knee joint to determine the extent of injury to your ACL and possible injury to other structures within your knee. Your doctor will treat other injuries, such as a torn meniscus, prior to reconstructing your ACL. Your own torn ACL will be removed arthroscopically. Your new ACL will be placed in the exact position as your previous ACL. Drill holes will be placed in the tibia and femur at the exact places the ACL will be. The graft will be pulled through these drill holes and will be secured inside the knee with screws or possibly staples. At this point, your ACL Reconstruction is complete.

After surgery you will be in the recovery room for an hour or so. You will have a knee brace that will help support your knee. If you have a drain, it will be removed prior to your discharge home. Patients undergoing ACL Reconstructions either go home the same day or the day after surgery. It is dependent on how you are feeling after surgery and the doctor's preference.

Physical therapy after surgery is a very important part of your recovery and starts soon after your operation. The successful outcome of your surgery is highly dependent on how committed a person is to their rehabilitation program. A person can return to their previous activity level or even exceed it depending on how committed they are to their rehab program.