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
