Anterior Cruciate Ligament Surgery

HOW DOES IT WORK?

What is anterior cruciate ligament surgery?

The anterior cruciate ligament (ACL) is one of four main ligaments within your knee. It connects the tibia to the thigh bone (femur). The ligament can become damaged over time through repetitive strain or impact. However, many people suffer a single, serious event that results in the complete rupture of the ligament. Anterior cruciate ligament surgery involves reconstruction rather than repair. Ligaments that are sewn back together with sutures usually fail. Instead, the ACL is replaced with a graft from another ligament in the body. Grafts can be taken from the patellar, the hamstring or the quadriceps.

How does anterior cruciate ligament surgery work?

1. Physical therapy

In most cases, surgery is delayed in order to give the initial injury time to heal. During this time, you may be given a course of physical therapy. A physiotherapist will work with you to regain movement and mobility. However, it might be necessary to wear a supportive brace. And depending on the severity of the injury, you may be given crutches or a wheelchair.

2. Anaesthesia and exploration

You and your surgeon will discuss anaesthesia options before the surgery takes place. You will be offered a general anaesthetic, but it's also possible to perform the surgery with the use of a spinal anaesthetic. This will mean you're awake throughout the procedure, but you won't feel any pain. Using an arthroscope, the surgeon will take a close look at the internal structures of your knee. The exact nature of your injury will be ascertained at this stage. The surgeon will also look for evidence of further injuries. It may be possible to fix these separate issues during the same procedure.

3. Grafting

Once the surgeon knows the extent and exact location of the injured ACL, the grafting process can begin. An autograft involves the use of tendon from another area of your body, such as the hamstring, the quadriceps or the patellar. An allograft involves the use of a donor's tendon. Some surgeons may recommend the use of a synthetic graft. The graft is removed carefully before being cut and shaped according to the nature of your injury. It's then put into place and attached to both the femur and the tibia (shin). One of the reasons why this surgery has become so effective in recent years is the improvement of arthroscopic technology. Arthroscopy is keyhole surgery that uses a thin and flexible tube that's filled with tiny fiber-optic cables. It is these cables that provide a source of light and relay pictures back to a monitor. The arthroscope guides the way, but it's usually necessary to make one or two more incisions for the insertion of other instruments. Using the pictures on the monitor for guidance, the surgeon will slowly remove damaged tendon. A small tunnel is drilled into the bone, through which the graft is fed. The new tissue is positioned in exactly the same place as the removed tissue, and it's held in place with staples or screws.

Are there different types of anterior cruciate ligament surgery?

In most cases, ACL reconstruction involves the steps mentioned above. However, some surgeons have their own, slightly different methods and procedures. Depending on the nature of the injury and your medical history, your surgeon may need to take a different approach. For example, open surgery is sometimes needed for widespread damage. It may be necessary to use several graft strands. Other options include femoral tunnel placement, extra-articular reconstruction and intra-articular reconstruction. Your surgeon will explain all the options - and the preferred course of action - well in advance of surgery.

What should I expect?

While the surgery itself doesn't last more than a couple of hours, the pain and immobility afterwards last for months. There's a long road to recovery, and it involves a lot of therapy and hard work. During the first two weeks after surgery, pain and inflammation will be at its worst. You will probably have to keep all your weight off your knee during this time.