Procedure for ACL Reconstruction

ACL Reconstruction Surgery

The Anterior Cruciate Ligament (ACL) is a fibrous tissue connecting femur and tibia at the knee joint. The function of ACL is to keep the knee joint stable during twisting actions leading to injuries,commonly seen in sports like football,hockey and skiing. It is a typical sports ACL injury that rarely heals completely and requires reconstruction.

ACL Reconstruction Surgery Procedure

Preparing for Anterior Cruciate Ligament Surgery includes surgeon’s consultation, pre-operative investigations, bone density tests and understanding the graft to be used. Prehabilitation is a must before surgery. General anaesthesia is not indicated for knee replacement surgery. It is performed under regional anaesthesia and sometimes under local.

The surgery is performed by making small incisions in the joint which helps:

• In faster post-surgery healing
• Reduced risk of complications

The ligament that has been torn/damaged is removed with keyhole surgery. Tunnels are made into the shin bone and thigh bone and the graft is positioned across the torn ligament in knee and secured at both ends. It has 90% chances of success if the joint is not extensively damaged and rehabilitation is done as per the advice of the physiotherapist.

ACL Statistics

ACL injury is 4-6 times higher in females than in males. The surgery has a success rate of 90% if rehabilitation is rigorously undertaken.

Approximate cost of ACL Reconstruction Surgery

The cost of ACL reconstruction surgery or arthroscopic knee surgery depends on:

• Graft used
• Type of procedure
• Facility
• Additional knee ligaments damage

Post -Op Care in ACL Reconstruction Surgery

• Patient is admitted in the morning for surgery
• Any local or general infections should be taken care of
• Patients should stop smoking
• 1 night stay after surgery is usually recommended
• Physiotherapy is started immediately post- operatively
• The patient can return to sports only after a year

Torn ACL Symptoms

Following are a few of the symptoms seen in a torn/damaged ACL:

• Tearing sensation
• A snap can be felt or heard
• Severe pain
• Swelling
• Dislocation of the joint

Initial Line of Treatment in ACL

Following should be the initial line of treatment or first aid in a torn ACL:

• Ice packs
• Compression bandages
• Crutches
• Seeking immediate medical attention/Consultation with a doctor

What are the Long Term Effects of This Injury?

This is a troublesome injury, and has various ill-effects that can be noted long term:

• Weakness of joint
• Full movement not possible
• Instability
• Injuries to cartilage
• Injury to joint
• Resulting in osteoarthritis

Indications for Surgery

Following are some of the indications for which ACL reconstruction is advised:

• Continuous pain
• Knees buckles during walking
• Healing is never complete
• Function of the knee joint is limited
• Stability of knee is not restored
• Conservative treatment is limited
• Young adults
• High level of sporting activity
• Surgical treatment brings back normalcy
• Prevents further degeneration of knee
• Prevents arthritis

The treatment also depends from patient to patient. There are usually two approaches for the treatment:

• Conservative treatment
• Surgical Approach

Ideal Candidates for Conservative Treatment

Conservative treatment is the best suited in:

• Older than 35 years
• No other additional knee problems
• No erosion of knee joint
• Patient is not too active

Ideal Candidates for Surgery

Surgical intervention is preferred in the following cases:

• Younger patients
• Erosion of knee joint
• Very active
• Sever pain
• Weakness of knee joint

ACL Tear Complications

As per the effects with respect to time, the ACL tear complications can be:

• Immediate
• Long Term

Immediate Complications include:

• Thrombosis and pulmonary embolism
• Pneumonia
• Infection within the joints
• Excessive bleeding
• Marrow exuding from surgery
• Red, swollen, painful shin.
• Risk injuring patella during harvesting of the graft

Long Term Complications are as Follows:

• Nerve injury
• Hamstring tear
• Graft failure
• Pain
• Stiffness
• Scar formation
• Tendinitis
• Pain when kneeling

Prehabilitation and Rehabilitation

Pre-operative and Postoperative exercises under the guidance of a physiotherapist is preferred.

The ACL tear rehabilitation as well as ACL recovery time is different for each knee.

The objective of rehabilitation is to:

• Reduce swelling
• Improving joint stability
• Improving motion
• Quick recovery
• reduce long term complications like stiffness and arthritis

In case of any recurring or persistent symptoms of pain, swelling or immobility the patient is advised to immediately consult the surgeon.