Anterior Cruciate Ligament (ACL) Reconstruction Surgery
Anterior cruciate ligament reconstruction surgery replaces the ACL ligament with a new ligament to improve stability and to decrease the chances of having cartilage injuries.
Who is a Candidate?
People who have knees that:
- Are unstable
- Tend to give away during activities
- Make them incapable of playing sports
What is Anterior Cruciate Ligament Reconstruction Surgery?
The ACL is a ligament in the center of the knee that prevents the shin bone (tibia) from moving forward on the femur (thigh bone). A tear of this ligament can cause the knee to give way during physical activity. If a torn ACL is left untreated, cartilage damage and early arthritis may occur.
ACL reconstruction is surgery to replace the torn ligament. There are several choices of tissue to use for the new ligament, including an autograft (tissue from the patient's own body) or an allograft (tissue from a donor). The most common autografts use part of the patellar tendon (the tendon in the front of the knee) or use the hamstring tendons.
The procedure is usually performed by having a camera inserted into the knee, which is known as knee arthroscopy. The camera is connected to a video monitor. The surgeon evaluates the cartilage and ligaments of the knee by viewing the monitor.
Additional small incisions are made around the knee to put the new ligament in place. The old ligament will be removed using a shaver. Bone tunnels will be made to place the new ligament in the knee at the site of the old ACL. If the patient's own tissue is to be used for the new ligament, a larger incision will be made to take the tissue. The new ligament is then fixed to the bone using screws or other devices. At the end of the surgery, the incisions are closed and a bandage is applied.
All-Inside Technique for ACL Reconstruction
The all-inside technique for anterior cruciate ligament reconstruction surgery is a minimally invasive procedure that replaces the ACL ligament with a graft. It's performed by making small poke-holes in the knee and without making any large incisions.
How is the All-Inside Technique for ACL Reconstruction performed?
The ACL is a ligament in the center of the knee that prevents the shin bone (tibia) from moving forward on the femur (thigh bone). The ACL ligament prevents the knee from being stretched or straightened beyond its normal limits. A tear of this ligament can cause the knee to give way during physical activity. An ACL injury usually involves a tear or separation of the ACL ligament from the bone. If a torn ACL is left untreated, cartilage damage and early arthritis may occur.
ACL reconstruction has evolved from an open procedure to an arthroscopically-assisted technique, by inserting a camera into the knee to view on a monitor. The arthroscopically-assisted technique reduces patient morbidity and improves rehabilitation time. However, ACL reconstruction has now been taken to the next level with the all-inside ACL reconstruction approach. These improvements and advancements have resulted in less pain and stiffness, fewer complications, and faster recovery time for the patient.
The all-inside ACL reconstruction approach secures the graft (portion of living tissue) into place. The graft is preassembled and ready to implant. The doctor will double fix the graft. There are 10mm tunnels made to insert screws. Putting the screws in the direction of the graft helps to pull the graft down into the tunnel. The doctor then extends the patient's leg to properly tighten the graft.
Benefits of the All-Inside Technique for ACL Reconstruction:
- There are no large incisions in the knee
- Re-establishes leg control
- Knee will have a normal range of motion
- Short rehabilitation and recovery time
- Walking without a limp sooner
- Decrease in post-operative pain
- Restore normal stability in the knee
- Limited loss of function in the knee
One of the main priorities after ACL reconstruction is to regain the knees range of motion. Establishing a good strengthening program is vital for a successful recovery. Crutches are usually needed for at least a week or two, with gradual progression to one crutch and finally to independent walking. Some surgeons prescribe a rehabilitation brace that is adjustable and can be locked in a straight position or set to allow a certain amount of movement.
A tear of the ACL used to be a career-ending injury for many athletes, but improvements in the surgery and in rehabilitation have lead patients back to their desired activities. These improvements have resulted in less pain and stiffness, fewer complications, and faster recovery time.