ACL reconstruction is usually not performed until several weeks after the injury. Studies have shown improved results when ACL reconstruction surgery is delayed several weeks from the time of injury. This time allows the inflamed and irritated knee to cool down. Swelling decreases, inflammation subsides, and range of motion improves. Resolution of swelling and stiffness prior to ACL reconstruction surgery improves the post-operative function of the joint.
Can the ACL be repaired?
ACL reconstruction surgery is commonly, and improperly, referred to as an ACL repair. Unfortunately, a torn ACL cannot be "repaired." Rather, the torn ligament must be entirely removed, and a new ACL must be reconstructed using other, healthy tissue. It is not possible to repair the torn ACL by simply reconnecting the torn ends.
How is the ACL reconstruction done?
The surgical procedure for an ACL reconstruction is variable, but commonly involves using a segment of another larger ligament or tendon to replace the damaged ACL. The ligament most commonly used is the patellar ligament which connects the kneecap (patella) to the tibia. About one-third of this ligament is removed and subsequently secured to the femur and tibia to replace the torn ACL.
The options that can be used for ACL reconstruction include:
- Patellar Ligament
- Hamstring Tendons
- Allograft (Donor Tissue)
Once the graft is chosen, what is next in the ACL reconstruction?
Once the decision is made to perform ACL reconstruction surgery, the procedure will be scheduled. As stated before, the surgery is usually done no sooner than one month after the injury. The procedure can be done as an in-and-out (same day) surgery, or you may stay overnight if needed. The anesthesia may be either general or regional anesthesia; you can discuss these options both with your surgeon and anesthesiologist.
The ACL reconstruction surgery lasts about 1 1/2 to 2 hours, depending on the graft choice and any other work that may need to be done in the knee joint. Following the procedure, you will be given crutches and may be given a knee brace. The decision to use a knee brace is controversial and can be discussed with your doctor. Some doctors also use a CPM (continuous passive motion) machine in the days following the ACL reconstruction. This is also controversial and may be discussed with your doctor.
What about the rehabilitation following ACL reconstruction?
This is probably the least emphasized and most important aspect of care for a torn ACL. Whether or not a patient is diligent about their therapy determines how well their knee will perform after ACL reconstruction. Most patients experience full recovery and resume their previous lifestyle, including professional athletes. However, some patients complain of pain, stiffness and limited motion in the joint for months or years following ACL reconstruction surgery.
What is the timeline for return to activities after ACL reconstruction?
Initially following ACL reconstruction, patients can expect to be using crutches from one to three weeks. Early in rehabilitation, emphasis is placed on control of swelling, flexibility of the joint, and return of strength. As range of motion improves, an increased emphasis is placed on recovering strength.
Swimming and cycling are excellent methods of strengthening the muscles around the knee. Muscle strengthening is critical not only to recover muscle mass lost due to surgery, but also to improve stability of the joint as increased muscle strength reduces stress on the joint ligaments. Finally, normal (not high-demand) activities (e.g. running) can be resumed at about two to four months following surgery. Most athletes in high-demand sports with cutting and lateral movement (e.g. soccer, basketball), can expect to return about six to seven months after surgical reconstruction.
Over 90% of patients are able to resume their previous level of activity after ACL reconstruction. A small percentage of patients will be limited by persistent pain or instability; however, changes in activity level following ACL reconstruction surgery are often due to choice rather than limitations of the knee joint.
