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ACL Reconstruction: All you need to know

Updated: Apr 21



Background

  • The Anterior cruciate ligament (ACL) is one of the major knee ligaments providing stability to the knee

  • The primary function of the ACL is to prevent the shin bone from moving forward relative to the thigh bone.

  • Injury to the ACL leads to knee instability and buckling, which is associated with pain and swelling

  • ACL tears usually occur after noncontact twisting injuries during sports

  • Patients oftentimes hear or feel a “pop” in their knee

  • Treatment of partial thickness ACL tears that are stable on physical exam are usually managed without surgery

  • Full or complete ACL tears are usually managed with surgery if patients want to maintain an active lifestyle playing sports and participating in twisting or change of direction

  • Patients should have improvement or resolution of their joint swelling and range of motion should be normalized prior to surgery

Figure 1. ACL Tear



Surgical Procedure

  • Knee ACL reconstruction is a surgery that is performed by replacing the torn ACL with a new ACL graft

  • There are numerous graft options, but in general younger patients use their own tissue (autograft) for the graft, while older patients may benefit from a donor graft (allograft)

  • Graft options include bone patella bone, hamstring, and quadriceps options. Outcomes are similar with all of these graft options

  • The goal of an ACL reconstruction surgery is threefold

  • Restore more normal knee anatomy by reconstructing the torn ACL

  • Improve knee stability, mechanics, and function

  • Decrease knee pain

  • Dr. Kandil performs all knee ACL surgeries arthroscopically-assisted with small portal incisions to minimize damage to muscle and expedite the healing and recovery process

  • These procedures are performed with visualization through a small fiberoptic scope. Instruments are inserted into the joint through two or three small incisions

  • Knee ACL reconstruction procedures are an outpatient procedure which generally take about 1-1.5 hours to complete

  • Most patients receive a regional nerve block prior to surgery to decrease amount of anesthesia and pain medications during and after surgery

  • Meticulous care and attention is taken during the procedure to ensure the highest likelihood of a successful surgery



Figure 2. ACL procedure from ACL tear to new ACL hamstring autograft reconstruction




What To Expect After Surgery

  • Sutures are removed at the first post-op appointment two weeks after surgery after which you may shower and have running water over incisions

  • You should not remove the Steri-Strips that cover the surgical incisions

  • Follow the rehab program provided to you after the surgery


Rehab and Physical Therapy

  • The patient will usually use crutches for the first 4-6 weeks. The protected weight bearing protects the knee while it heals.

  • During this protected weight bearing period, hip, knee, and ankle motion are maintained with gentle range of motion exercises

  • Physical therapy begins immediately after surgery

  • Exercises stressing range of motion are the focus of the 3 months after surgery

  • Knee strengthening begins at 3 months following surgery


Expected Recovery Time

  • Time off work is usually between 1 week to 6 months depending on the nature of the job

  • Running begins at 4 months after surgery

  • Cutting and pivoting activities generally begin at 6 months after surgery

  • Contact sports are restricted for six to nine months




Figure 3. ACL reconstruction








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