What Is ACL Reconstruction Surgery?

The ACL, or anterior cruciate ligament in medical terms, is one of the four ligaments that support the knee, connecting the femur and tibia bones – it's a small band of fibrous tissue that plays a major role in knee functionality.

The ACL mainly ensures the knee joint's stability during activities that involve turning, cutting, twisting, and pivoting. Unfortunately, such brusque motions can hyperextend and damage the ligament leading to a painful injury that athletes are all too familiar with.  

When the body moves in a way that the ACL can't support, it can lead to a sprain, partial tear, or a complete rupture of the ligament. They commonly occur during jumps, turns, or sudden motions while running or playing sports. The most indicated solution is reconstructive surgery when an ACL suffers a total tear.

Before the procedure, patients usually undergo a few weeks of physical therapy to mitigate swelling and pain, reinforce muscles and restore the joint's full range of motion. Not doing so can result in further knee mobility issues after the intervention.

The Procedure Itself

Prior to starting the operation, the patient receives general anesthesia. The surgeon makes 2-3 minor incisions in the knee to allow access for the surgical instruments. After flushing the knee's interior with a sterile saline solution, the surgeon inserts the operating tools, cutting and removing the damaged ACL.

After drilling a hole or tunnel in the femur and tibia bones, the next step is to place the replacement tendon (graft) in both openings and anchor the new ligament using sutures or screws. 

Grafts come in two varieties:

  • Autograft – When the graft is harvested from the patient's patellar, quadriceps or hamstring tendons
  • Allograft – When the graft is harvested from a donor that passed away

Since additional ligaments and tendons in the knee may be damaged from the initial injury, surgeons may also clean out the joint and repair them to ensure no further complications arise after the intervention. 

Depending on the extent of the damage, ACL reconstructive surgery can last up to two hours. Given that ACL reconstruction is an outpatient intervention, patients are able to go home the same day as the surgery once the anesthesia wears off. Even so, it is advisable that patients have a designated driver to take them home. 

After completing the procedure, patients may have to practice walking using crutches. It may be recommended to wear a knee brace or splint to ensure that the newly inserted graft is protected. The doctor will also provide instructions on reducing swelling and pain during the days of rest before the required physical therapy to ensure a safe recovery.