The anterior cruciate ligament (ACL) is found inside your knee joint and crosses with the posterior cruciate ligament (PCL) to form an ‘X’ in the center of your knee. The cruciate ligaments provide stability of the knee by controlling the back and forth motion of your knee, as well as provides rotational stability.
ACL injuries most commonly occur during sports and fitness activities that involve sudden stops and changes in direction — such as basketball, soccer, football, downhill skiing, and gymnastics where a lot of stress is put on the knee:
- Suddenly slowing down and changing direction (cutting)
- Pivoting with your foot firmly planted
- Landing from a jump incorrectly
- Stopping suddenly
- Receiving a direct blow to the knee
The knee becomes unstable with a ruptured ACL and the joint may become more damaged over time. Surgery immediately after the injury has been associated with increased fibrous tissue leading to loss of motion and increased stiffness after surgery. Some surgeons recommended that you start exercises with a physical therapist immediately after the injury occurs. The goal of physical therapy before surgery is to reduce pain and swelling, restore your knee's full range of motion, and strengthen muscles. People who go into surgery with a stiff, swollen knee may not regain full range of motion after surgery.
ACL Reconstruction is the surgical treatment of choice. In ACL reconstruction, the torn ligament is removed and replaced with a piece of tendon from another part of your knee (autograft) or from a deceased donor (allograft).
During arthroscopic ACL reconstruction, the surgeon makes several small incisions around the knee. Sterile saline solution is pumped into the knee through one incision to expand it and to wash blood from the area. This allows the doctor to see the knee structures more clearly.
The surgeon inserts an arthroscope into one of the incisions. A camera at the end of the arthroscope transmits pictures from inside the knee to a TV monitor in the operating room.
Surgical drills are inserted and the surgeon drills small tunnels into the upper and lower leg bones where these bones come close together at the knee joint. The graft is pulled through the tunnels and the surgeon secures the graft with hardware such as screws, buttons, or staples. The surgeon may also repair other injured parts of the knee such as menisci, other knee ligaments and cartilage. The incisions are closed with stitches, glue, or tape. The knee is bandaged, and you are taken to the recovery room as you wake up from anesthesia.
The goal of ACL surgery is to restore normal or almost normal stability in the knee and the level of function you had before the knee injury.
Not all ACL tears require surgery. You and your doctor will decide whether physical therapy only or surgery plus rehab is right for you.
You may choose to have surgery if you:
- Have completely torn your ACL or have a partial tear and your knee is very unstable.
- Have gone through a rehab program and your knee is still unstable.
- Are very active in sports or have a job that requires knee strength and stability (such as construction work), and you want your knee to be as strong and stable as it was before your injury.
- Are willing to complete a long and rigorous rehab program.
- Have chronic ACL deficiency, which is when your knee is unstableand it affects your quality of life.
- Have injured other parts of your knee, such as the cartilage or meniscus, or other knee ligaments or tendons.
A course of physical therapy may successfully treat an ACL injury for individuals who are relatively inactive, engage in moderate exercise and recreational activities, or play sports that put less stress on the knees.
Risks of Surgery
Potential risks associated with ACL reconstruction include bleeding and infection at the surgical site, knee pain or stiffness, blood clot, poor healing of the graft, and graft failure after returning to sport.
Once you recover from the anesthesia, you can go home later that same day. Before you go home, you will practice walking with crutches, and you will wear a knee brace or splint to help protect the graft.You will likely feel tired for several days. Your knee will be swollen, and you may have numbness around your knee. Your ankle and shin may be bruised or swollen. You can put ice on the area to reduce swelling. Most of this will go away in a few days, and you should soon start seeing improvement in your knee.
Successful ACL reconstruction paired with focused rehabilitation can usually restore stability and function to your knee. Within the first few weeks after surgery, you should strive to regain a range of motion equal to that of your opposite knee. Recovery generally takes about nine months.It may take eight to 12 months or more before athletes can return to their sports.A repeat injury or rupture of the graft can happen. Unfortunately, repeat surgery is more complicated and less successful than the first surgery.