Anterior Cruciate Ligament (ACL) Surgery
Anterior cruciate ligament (ACL) repair is done to reconstruct the ACL in the knee after it is torn. Often, a graft made of tendon is used to reconstruct the torn ligament.
Anterior Cruciate Ligament Injury
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ACL surgery is an elective procedure. This means that surgery is not always necessary; it may depend on your lifestyle and age.
Surgery may be recommended if you have:
- A complete tear of the ACL
- A high degree of joint instability
- Injury to the knee that affects more than one ligament
- A need to return to sports or other activities that require pivoting, turning, or sharp movements
- No improvement with rehabilitative therapy
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Excess bleeding
- Blood clots
- Reaction to anesthesia
- The operation does not provide the desired improvement in function
- Instability of the knee
- Numbness or stiffness in the knee
- Kneecap pain after surgery
Smoking may increase the risk of complications and slow healing.
Prior to Procedure
Your doctor may do the following:
- Physical exam
- Blood tests
- Knee x-ray
- MRI to see the internal structure of the knee
Before surgery, you will need to:
- Arrange for help at home while you recover
- Talk to your doctor about any medications, herbs, or supplements you are taking
- Talk to your doctor about any allergies you have
- Ask your doctor about assisted devices you will need
You may need to stop taking some medications up to one week before the surgery. Medications that may need to be stopped may include:
- Aspirin or other anti-inflammatory drugs, such as ibuprofen or naproxen
- Blood-thinning drugs, such as warfarin
- Anti-platelet drugs, such as clopidogrel
Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.
Anesthesia will block pain and keep you comfortable during the procedure. Anesthesia methods include:
- General anesthesia is given through an IV. You will be asleep during the procedure.
- Spinal anesthesia is given through the spine. The doctor may give you a sedative to keep you relaxed and ease anxiety.
Description of the Procedure
IVs will be placed in your arm or hands for medications and fluids. The doctor will examine the range of motion of the knee and confirm the ACL tear. Next, the doctor will locate another tendon in your knee or hamstring (called autograft) to reconstruct the torn ligament. Sometimes a donor graft (called allograft) is used. The doctor will form the graft tendon to the correct size.
One or two small keyhole incisions will be made on the top of the knee. An arthroscope (or endoscope) and tiny tools will be inserted into the knee joint. The torn ACL is removed and other damage to the knee is trimmed or repaired. In order to reconstruct the tendon, the doctor will drill holes through bone structures in the thigh and shin. The new graft will be placed through these holes. Needles may be threaded through the holes to suture the new tendon into place. Other devices, such as screws, washers, or staples are also used to hold the graft in place.
Once the graft is securely in place, the doctor will test the knee’s range of motion. Other tests will be done as well. The skin will be closed with stitches. Bandages and/or a brace will be placed on the knee.
How Long Will It Take?
About two hours.
How Much Will It Hurt?
Anesthesia will block pain during the procedure. You will have pain after the procedure. Ask your doctor about medication to help manage pain.
Average Hospital Stay
This procedure is done in a hospital setting. You can usually go home the same day. If you have complications, you may need to stay longer.
At the Hospital
After the procedure, the hospital staff may provide the following care:
- Monitor your vital signs as you recover from the anesthesia.
- Medication to manage pain.
- Antibiotics to prevent infection.
- Medication that prevents blood clots.
- Place ice packs on your knee.
- Show you how to use a continuous passive motion machine.
- Teach you how to use crutches or knee brace.
When you return home, take these steps:
- Take pain medication as directed.
- Use crutches or knee brace for as long as the doctor recommends.
- Work with a physical therapist.
- Gradually begin low impact activities, such as swimming or cycling, to strengthen the knee.
- Keep the incision area clean and dry.
- Ask your doctor about when it is safe to shower, bathe, or soak in water.
- Be sure to follow your doctor’s instructions.
After arriving home, contact your doctor if any of the following occurs:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Swelling, pain, or heat in your calves
- Pain cannot be controlled with medications given
- Nausea or vomiting
- Cough, shortness of breath, or chest pain
- Numbness in the knee area
- Trouble urinating
- New or worsening symptoms
If you think you have an emergency, call for medical help right away.