FAQs on ACL Reconstruction in Gilbert, Chandler & Mesa AZ
About 200,000 people suffer from anterior cruciate ligament (ACL) injury every year and almost 50% or about 100,000 ACL reconstructions are performed annually in the United States. The majority of patients are from high-risk sports background, including gymnasts, wrestlers, skiing pros, NFL player, and NBA stars. Many common people also go for the procedure, as 70% of ACL injuries are traced to non-contact mechanism.
What is ACL reconstruction?
ACL reconstruction is the procedure of removing the torn anterior cruciate ligament and replacing it with a surgical tissue graft. The word reconstruction refers to rebuilding the damaged ligament that was torn and unable to keep up with the pressure on the knee. Performed under arthroscopic guidance, the method is an effective way to restore the structural and functional strength of the knee ligament.
What is ACL?
The anterior cruciate ligament or ACL is one of the four knee ligaments entrusted with keeping the joint stable by preventing “the tibia from sliding out in front of the femur.” A “crossed ligament in the middle of the knee”, it saves the knee joint from excessive twisting.
How does ACL get injured?
ACL injury occurs when the ligament is sprained, partially torn, or completely ruptured. Pivoting maneuvers, sudden change of direction, excessive pressure, and forceful contact cause the knee the buckle inward. This leads to ACL injury manifested through knee pain and restricted knee mobility. ACL rupture left untreated may cause further damage to the knee and its shock absorbing cartilages and injury to surrounding bones.
ACL reconstruction rebuilds the ruptured ligament using a graft replacement.
What are sources of grafts used for ACL reconstruction?
The ACL reconstruction surgery is divided into three types based on the source of graft.
- Autograft ACL reconstruction, where tissue to be grafted is harvested from the patient himself. Autograft tissues are obtained from patellar tendon, quadriceps tendon, or hamstring of the patient.
- Allograft ACL reconstruction, where tissue to be grafted is harvested from a cadaver or live donor. The graft is obtained from donors’ patellar tendon, frontal tendon in the tibia, or Achilles tendon.
- Synthetic grafts
Who is a candidate for ACL reconstruction?
- Those who have Grade 3 or ruptured ACL.
- Those who have frequent ACL tears
- Those who don’t have success with conservative ACL injury treatment methods
- Those with continued knee buckling or instability.
- Young patients with high-impact activities
- Knee giving away regularly restricting performance of daily activities
How ACL reconstruction is performed?
The ACL construction process undergoes different stages.
- Pre-operative preparation: Doctors recommend pre-operative rehabilitation prior to surgery to cut down the swelling in the knee. MRI is done to assess the condition of soft tissues, bones, and other ligaments in the knee. This allows the best possible surgical planning.
- Graft Harvesting (for autograft): The patient is administered general anesthesia and a tight band is wrapped around his upper thing. An incision is made on the thigh to remove a hamstring tendon using tendon stripper. Similar procedure is adopted for harvesting grafts from patellar tendon or frontal tendon in the tibia.
- Damaged Ligament Removal: Once the graft is prepared with due size and shape, an arthroscope is put into the joint through a small incision. It helps visualize damage to the knee. If any associated injury is discovered, it is addressed. The torn ACL is removed.
- Graft Implant: A tunnel is made through the tibia and femur and the graft is pulled into the right position using a long needle. Screws and spiked washers are used to fix the graft ligament. The opening is closed and an anaesthetic injection is applied to the place to control post-operative pain.
How long does it take?
ACL reconstruction procedure takes around 1 ½ to 2 hours.
Do I need to stay at the hospital after the ACL reconstruction procedure?
The surgery is a day-care procedure and you can go home after a few hours once the effect of general anesthesia is gone. However, any symptom of post-operative complication may require you to stay under hospital supervision.
Do I need rest ACL reconstruction surgery?
You need rest for two days and join the desk job thereafter. Light knee-impact activity can be resumed after five weeks. You can drive after a week if the left leg is operated. For the right leg implant, you have to wait for three weeks. Heavy pressure on the knee is allowed only after four to six months. You can go back to sports after six months.
How long should I use knee brace or immobilizer?
It is advisable to use knee brace for four to six weeks in case of light activities. Having it for at least six months is recommended for high-impact activities. Immobilizer is suggested for the first three to four weeks to prevent twisting and safeguard your knee from risky situations.
Do I need secondary surgery to remove screws in the ligament are?
No. Made from a special sugar compound, these screws dissolve inside the knee after a few months.
Do I need physical therapy following ACL reconstruction surgery?
You need to have progressive physical therapy after the procedure. The schedule may include full extension and flexion during the first week, moderate movements from second to sixth week and load increasing exercises until the 12th week. Continue your physical therapy at least for six months to regain the knee strength.
How long is the recovery period following ACL reconstruction?
You can perform desk jobs following two-day rest. Partial improvements are visible in three to four weeks. However, you need to follow rehab for four to six months to have complete recovery and knee strength regain.
What are the potential complications of ACL reconstruction surgery?
Surgery related complications may occur if the standard ACL reconstruction procedure is not followed. This may lead to avoidable complications, such as infection, blood clots, bleeding, nerve injury, tear of the graft, hamstring-related problems, knee stiffness, and implant irritability. Rare side effects, including knee weakness, knee cap pain, graft failure, continued knee instability, may also occur.
What are the benefits of the ACL reconstruction?
Expert ACL reconstruction and proper rehab results in 100% success rate. It has become the best possible ACL injury treatment option for young people and athletes.
Lyman S, et al. Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am. Oct 2009;91(10):2321-8
Mohtadi NG, et al (Sep 7, 2011). “Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults.” Cochrane Database of Systematic Reviews 9 (9)
O’Brien, DF et al (2014). “Allograft anterior cruciate ligament reconstruction in patients younger than 30 years: A matched-pair comparison of bone-patellar tendon-bone and tibialis anterior”. Am J Orthop 43 (3): 132–136
Kraeutler MJ, et al. Bone-patellar tendon-bone autograft versus allograft in outcomes of anterior cruciate ligament reconstruction: a meta-analysis of 5182 patients. American Journal of Sports Medicine 2013;41(10):2439-2448.
Pinczewski et al (2007). “A 10-Year Comparison of Anterior Cruciate Ligament Reconstructions With Hamstring Tendon and Patellar Tendon Autograft”. The American Journal of Sports Medicine
Marrale J, et al (12 April 2007). “A literature review of autograft and allograft anterior cruciate ligament reconstruction”. Knee Surgery, Sports Traumatology, Arthroscopy 15 (6): 690–704.