The anterior cruciate ligament, or ACL, is a ligament in the knee that plays a crucial role in providing stability to the joint. It connects the thighbone (femur) to the shinbone (tibia) and helps prevent the tibia from sliding out in front of the femur.
If the ACL is torn, it can cause the knee to become unstable, making it difficult to perform activities that require pivoting or twisting.
Treatment options for a torn ACL will depend on the severity of the injury and the individual's physical activity goals. In some cases, physical therapy and rehabilitation can help to improve stability and strengthen the surrounding muscles. However, in many cases, surgical reconstruction of the ACL is necessary to restore full function to the knee.
ACL reconstruction surgery is typically performed using arthroscopic techniques, which involves making small incisions in the knee and inserting an arthroscope (a small camera) to visualize the inside of the joint. The surgeon will then use specialized surgical instruments to repair or replace the damaged ACL.
In most cases, the surgeon will use a tissue graft to reconstruct the ACL. Although in certain circumstances an ACL repair is possible.
There are several different tissue graft options that can be used for ACL reconstruction surgery. The type of graft that is used will depend on a number of factors, including the patient's age, overall health, and the condition of the knee.
The most common graft options for ACL reconstruction surgery include:
Autografts: Autografts are tissue grafts that are taken from the patient's own body. The autografts that I use for ACL reconstruction are the patellar tendon, which is taken from the front of the knee, or the quadriceps tendon, which are taken from a tendon just above the knee cap. Autografts have the advantage of being less likely to be rejected by the patient's body, and they can provide good long-term stability and function. Furthermore Autografts have an overall shorter recovery and lower failure rates in certain patient populations.
Allografts: Allografts are tissue grafts that are taken from a donor. The tissue is carefully screened and processed to minimize the risk of rejection or disease transmission. Allografts can be a good option for patients who do not have suitable autograft tissue, for patients who are at high risk of complications from autograft surgery, or for patients who wish to avoid pain/discomfort from an autograft harvest.
In rare cases, a combination of these graft options may be used to reconstruct the ACL. The decision about which graft option to use will be made by the surgeon, based on the individual needs of the patient.
Once the tissue graft is in place, the surgeon will use special surgical techniques to secure the graft in the knee and ensure that it is properly aligned. The incisions are then closed and the knee is typically immobilized in a brace to allow for proper healing.
The post-operative recovery from ACL surgery can vary depending on a number of factors, including the patient's age, overall health, and the type of surgical procedure that was performed. In general, however, most people can expect to follow a similar recovery timeline after ACL surgery.
Immediately after the surgery, the knee will be immobilized in a brace to protect the repaired ligament and allow for proper healing. You will typically be given pain medication, anti-nausea medication, baby aspiring to prevent blood clots, a medication to prevent constipation and sometimes antibiotics.
You are usually allow to bear full weight on the leg with crutches, unless additional procedures were performed.
A knee brace is typically worn for 4 weeks, including while sleeping. Physical therapy starts Post op day 2.
During the first few weeks of recovery, the focus will be on reducing swelling and improving range of motion in the knee. The patient will be prescribed physical therapy exercises to help restore strength and flexibility in the knee. The therapist may also use techniques such as ice, heat, and electrical stimulation to help reduce pain and swelling.
As the knee begins to heal and the patient's strength and mobility improve, the therapist will gradually increase the intensity and complexity of the physical therapy exercises. The patient may also be encouraged to perform activities such as walking, biking, and swimming to help improve overall fitness and function.
It can take several months for the knee to fully heal after ACL surgery. Most people can return to their normal activities within 3-6 months, although some may take longer to fully recover. The exact timeline will depend on the individual's progress and the therapist's recommendations. Although recovery is dictated by progress in therapy, rough time line to return to sports are 9 months for Autograft and 12 months for Allograft.
It is important for the patient to follow the therapist's instructions and attend all physical therapy sessions as scheduled. This will help ensure a successful recovery and allow the patient to return to their normal activities as soon as possible.