The anterior cruciate ligament (ACL) is a commonly injured knee structure. Around 200,000 people injury the ACL each year, and half of these cases require ACL reconstruction surgery. The risk of ACL injury is greater for people who participate in high-impact sports, such as football, basketball, soccer, and skiing. About half of ACL injuries occur along with a meniscus tear, articular cartilage injury, or trauma to another ligament of the knee.
The mechanism of ACL injury is often associated with slowing down (deceleration) coupled with pivoting, cutting, side-step maneuvers, out of control play, and awkward landings. Only 30% of ACL injuries are the result of a direct blow or contact with another player. Female athletes are more at risk for ACL tears.
So, if you have suffered an ACL injury, you may be wondering, “Should I have ACL reconstruction or not?” It is a natural reaction to question the need for surgery. There are some things to consider before surgery, and a visit with a Los Angeles sports medicine surgeon is recommended. Find out if you are a candidate for ACL reconstruction surgery by answering these questions.
- Are you involved in sports? Active athletes who play a sport that requires turning, pivoting, and/or cutting are encouraged to have surgical ACL reconstruction.
- Are you an active adult? Adults who do heavy manual work or jobs that require turning and cutting should consider surgical repair of an ACL injury.
- Do you have functional instability? Any patient with a torn ACL who has an unstable knee has the risk of developing secondary knee damage. Therefore, he/she should have the ACL reconstruction procedure.
- Do you have other ligament or tendon damage? The “unhappy triad” that is often seen in football players and skiers involves injuries o the ACL, the medial cruciate ligament (MCL), and the medial meniscus. In cases where there are combined injuries, such as the unhappy triad, surgical repair is warranted for the best outcome.
- Is the ACL only partially torn? The prognosis is better for a partially torn ligament compared to a completely torn one. In addition, the rehabilitation/recover period is shorter, with some patients using the knee within three months. Complete ACL ruptures do not have as high of success rate following surgery.
- Is the patient a child, teen, or elderly person? The surgical reconstruction of the ACL is not indicated for children or teens whose growth plates are still open, people who live sedentary lifestyles, those who have complete tears who are planning to stop playing high-demanding sports, and people with no instability symptoms.
ACL Reconstruction Surgery with a Beverly Hills Orthopedic Surgeon
ACL reconstruction surgery is often done using the arthroscopic technique. The surgeon uses an arthroscope (flexible tube with a camera) that is inserted through small incisions made around the knee. Also, the doctor uses small instruments to make repairs through these same incisions. A graft is used to replace the torn ACL, which can come from the patient (autograft) or a cadaver (allograft). Common tendons include the hamstring, patellar, or quadriceps.
The meniscus and cartilage injuries are shaved and repaired, and the torn ACL stump is removed. The surgeon drills bone tunnels into the upper and lower leg bones so the graft can be positioned. The graft is held in place using screws, posts, washers, and/or staples. Variations of this surgery are done, depending on the preference of the surgeon or when special circumstances present. The incisions are sutured closed, dressings are applied, and a postoperative brace is positioned on the knee.
During the first couple of weeks, the surgical wounds are kept clean and dry. Physical therapy begins immediately after the ACL reconstruction, as stronger graft fixation allows for accelerated rehabilitation. The surgeon may order use of the postoperative brace, as well as a range of motion machine. The goals of rehabilitation are to:
- Reduce knee swelling
- Regain full range of motion of the knee joint
- Maintain mobility of the kneecap
- Prevent pain
- Strengthen the hamstring and quadriceps muscles