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ACL Reconstruction Surgery: An Overview


ACL reconstruction is a surgical procedure aimed at replacing the torn ACL in the knee with a tissue graft.

A tear in the anterior cruciate ligament (ACL) is one of the most common injuries among athletes, particularly those involved in high-intensity sports like football, soccer, and basketball. This injury can range from a partial to a complete tear, with varying degrees of severity. In cases of complete tears, surgical intervention is often the best course of action to restore knee stability and prevent further injury.


This article provides a comprehensive overview of ACL reconstruction surgery, the process involved, the recovery timeline, and its benefits for patients.


What is ACL Reconstruction Surgery?

ACL reconstruction is a surgical procedure aimed at replacing the torn ACL in the knee with a tissue graft. The ACL is a critical ligament that provides stability to the knee, allowing for controlled movement during activities that involve cutting, pivoting, and jumping. When torn, the knee becomes unstable, increasing the risk of further damage to the meniscus and cartilage.


Do You Need ACL Surgery?

The decision to undergo ACL surgery depends largely on the severity of the tear and the patient’s lifestyle. For individuals who have sustained a complete ACL tear and lead an active lifestyle—especially athletes—reconstruction surgery is usually recommended. It allows patients to return to their previous level of activity while preventing future injuries.


In contrast, for individuals with partial tears or those who don’t engage in high-impact sports, non-surgical treatments may be an option. Physical therapy and rehabilitation can help strengthen the knee and allow patients to return to everyday activities without the need for surgery.


How Soon Should ACL Surgery Be Performed?

For patients with a complete ACL tear, surgery is typically scheduled 3 to 6 weeks after the injury. This waiting period allows for inflammation to subside and gives the patient time to work on restoring knee flexibility through physical therapy. Delaying surgery beyond 3 months can lead to further knee instability, increasing the risk of additional injuries like meniscus tears.

Orthopaedic surgeons will assess the timing of the surgery based on various factors, such as the extent of knee swelling, pain levels, range of motion, and whether there are other injuries that need to be addressed first.


How Does ACL Reconstruction Surgery Work?

In ACL reconstruction surgery, a tissue graft is used to replace the damaged ACL. This graft can either come from the patient’s own body (typically from the hamstring, patellar, or quadriceps tendon) or from a donor (allograft). The type of graft chosen depends on various factors, including the patient's age, activity level, and overall health.


The surgery is usually performed using minimally invasive arthroscopic techniques. Small incisions are made around the knee, and a fibre-optic camera is inserted to guide the surgeon during the procedure. The surgeon then removes the damaged ligament and replaces it with a tissue graft. Over time, this graft will integrate into the knee, mimicking the natural ACL.


Recovery Timeline for ACL Surgery

Recovery from ACL reconstruction surgery typically takes 9 to 12 months. However, this can vary depending on the individual’s progress in rehabilitation, the type of sport they play, and their overall health.


Immediately after surgery, patients can begin walking with crutches and a brace. A rehabilitation program usually starts 2 to 3 days post-surgery, focusing on restoring knee strength, stability, and range of motion. Quadriceps strengthening exercises are introduced early in the recovery phase, while running and pivoting exercises are typically initiated 3 to 5 months into recovery.


Athletes involved in sports requiring quick directional changes or pivoting may need to wait up to 12 months before returning to full competition.


Types of ACL Surgery

There are two primary types of ACL surgery: reconstruction and repair. ACL reconstruction is the most common and involves rebuilding the ligament with a tissue graft. This approach has been proven to reduce the risk of future injuries and prevent osteoarthritis of the knee.


On the other hand, ACL repair involves stitching the torn ligament back together. Although this technique may lead to quicker recovery, it has a higher failure rate, especially in younger patients. Because of this, ACL repair is not as widely recommended as reconstruction.


Can Teenagers Have ACL Surgery?

Yes, teenagers can undergo ACL reconstruction surgery, but special care must be taken. Pediatric patients are still growing, and the surgical technique must avoid damaging the growth plates in the bones. Surgeons often use specialized techniques like the All-Epiphyseal Reconstruction (AE-ACLR) or grafts from the iliotibial band to perform the surgery without compromising the child’s growth.


Advances in ACL Surgery at HSS

Research at the Hospital for Special Surgery (HSS) has led to advancements in predicting patient outcomes after ACL surgery. Machine learning algorithms are now being used to assess factors that can impact recovery and return-to-sport timing. These tools allow for more personalized treatment plans, helping patients achieve better outcomes both in the short term and long term.


Equipment you may require in ACL reconstruction surgery post-care

Post-ACL reconstruction surgery, proper equipment and tools such as hospital beds and wheelchairs can significantly aid in the recovery process. Here’s a list of commonly recommended equipment for effective post-surgical care:









Conclusion

ACL reconstruction surgery is a highly effective treatment for those with complete ACL tears, especially athletes who wish to return to their previous activity levels. With advancements in surgical techniques and personalized rehabilitation programs, patients can expect to regain knee stability and strength. Recovery from ACL surgery requires time, dedication to physical therapy, and close collaboration with healthcare providers to ensure optimal outcomes.


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