Chesapeake Orthopaedic and Sports Medicine Center

Information for our patients and community

ACL Surgery

ANTERIOR CRUCIATE LIGAMENT INJURY & RECONSTRUCTION

When you twist your knee or fall on it, you can tear a stabilizing ligament that connects your thighbone to the shin bone. An anterior cruciate ligament (ACL) unravels like a braided rope when it’s torn and does not heal on its own. Fortunately, reconstruction surgery can help many people recover good function after an ACL tear.

Ligaments are tough, non-stretchable fibers that hold your bones together. The cruciate ligaments in your knee joints crisscross to give you stability on your feet. People often tear the ACL by changing direction rapidly, suddenly slowing down from running or landing from a jump. Young people (age 15-25) who participate in basketball, soccer, football and other sports that require pivoting are especially vulnerable. You might hear a popping noise when the ACL tears. Your knee gives out and soon begins to hurt and swell.

First treatment includes rest, ice compression and elevation (RICE) plus a brace to immobilize the knee, crutches and pain relievers. Get to your doctor right away to evaluate your condition.

Evaluation

Your doctor may conduct physical tests and take X-rays to determine the extent of damage to your ACL and evaluate for other potential knee damage. Most of the time, you need reconstructive surgery. Your doctor replaces the damaged ACL with strong, healthy tendon tissue taken from another area near your knee. A strip of tendon from under your kneecap (patellar tendon) or hamstring may be used. Your doctor threads the tissue through the inside of your knee joint and secures the ends to your thighbone and shin bone (femur and tibia).

In a few cases when the ACL is torn cleanly from the bone it can be repaired. Less active people may be treated non-surgically with a program of muscle strengthening.

Possible Risks

Some of the potential risks and complications of ACL reconstruction and other similar surgeries include but are not limited to: Excessive pain, wound healing problems, infection, blood clots in the leg, or rarely, blood clots breaking off and going to the lung; some numbness in the front of the knee (a normal consequence of this and other knee surgery). Other risks include incomplete recovery of range of motion, weakness, residual stiffness, difficulty kneeling and weather-ache. The ACL graft may stretch and loosen a tiny bit in the first few months. Rarely it can stretch a lot or be damaged and negate the benefit of the reconstruction.

The risks of revision ACL surgery (reconstruction of an ACL that was previously reconstructed) are higher than first-time surgery.

Outcome

Successful ACL reconstruction surgery tightens your knee and restores its stability. It also helps you avoid further injury and get back to playing sports. In the U.S., doctors see more than 95,000 ACL tears each year and perform about 50,000 ligament reconstructions. The surgeries are successful about 85-92 percent of the time.

After ACL reconstruction, you’ll need to do rehabilitation exercises – exercises at home and with a physical therapist to gradually return your knee to full flexibility and stability. Building strength in your thigh and calf muscles helps support the reconstructed structure. Most people work with a physical therapist for at least three to four months in order to restore enough function to return to high-level sports or to a physically demanding job. You may need to use a knee brace for awhile and will probably have to stay out of sports for four to six months after the surgery.

DISCHARGE INSTRUCTIONS:

Note: It may take 3 to 6 weeks for the swelling and pain to go away and to get full movement in your knee.

These rehabilitation guidelines are for purely ACL reconstructive surgery. If other things are done (such as meniscus cartilage repair) your doctor may change or delay what you do within the first few weeks after the surgery.

Home Range of Motion exercises:  Restoring the ability for the knee to move through its normal range of motion usually starts immediately on the day of surgery. The goal is to achieve a range of zero degrees (fully straight) to ninety degrees (bent square like sitting in a chair) within the first week after surgery. It is painful to do this but very beneficial to the knee and critical to getting your motion back.

Starting on the day of surgery and several times per day, put your foot up on a pillow or small stool and place both hands on your thigh and press and hold down for a “slow count to fifteen by thousands (one – one thousand – two one thousand three ….  etc.” to work on getting the knee straighter. Next, practice bending the knee into flexion – this time doing a sustained pull on the leg to achieve bending -- for a slow count to fifteen by thousands.

 Your doctor will usually have you use crutches for about three weeks and usually allow light partial weight bearing on the repaired leg during that time.

 Use ice or a “Cryo cuff” or other cold compressive device supplied by your doctor very frequently during the first month after surgery. This will help greatly to reduce swelling and pain.

 Mild to moderate swelling in the entire leg and ankle is normal after ACL reconstructive surgery. Sitting with the leg elevated is usually not very effective enough at reducing swelling. Instead, lay down with the leg elevated very high on multiple folded blankets or pillows particularly during the first week after surgery to also help to reduce swelling.

 Use the narcotic and anti-inflammatory pain medicine that your doctor prescribed. It will help with pain reduction and make it easier to be up and around especially in that first week. Do not take anti-inflammatory medicine if you are allergic to aspirin, have ulcers, or kidney disease.

Call your doctor if:

Your pain and swelling increase, or have calf pain.

You have new symptoms.

You have a temperature over 100.4° F (38° C).

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Link to AAOS Patient Info

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Chesapeake Orthopedic & Sports Medicine Center 200 Hospital Drive Glen Burnie, MD 21061 410-768-5555; www.chesortho.com; www.orthopedicdoc.net