ACL Reconstruction Overview
When the anterior cruciate ligament (ACL) tears, a knee is likely to become unstable. The ACL provides stability to the joint and prevents the lower leg from sliding forward in relation to the upper leg. In some cases training of the muscles surrounding the knee can restore stability; however, in most cases, surgical reconstruction of the ACL will be necessary to restore stability and prevent further damage to the knee. This is done arthroscopically by transplanting part of the patella tendon, the hamstring tendons, or a cadaver graft into the original ACL position.During ACL reconstruction, Dr. Millett will use several small incisions and will insert an arthroscope to view the ligaments and other structures within the knee. The surgery will involve removing the damaged ACL and replacing it with another soft tissue, called a graft. There are two types of grafts used during arthroscopic ACL reconstruction surgery:
- An AUTOGRAFT will use soft tissue from the patient
- An ALLOGRAFT will use soft tissue donated from another individual at the time of death. All allograft tissues are tested to make sure there are no communicable diseases.
Dr. Millett usually prefers to use a patient’s own tissue for the graft. The patient’s own tissue typically heals faster and reduces other known risks (disease, rejection, etc.). In patients who are older, who have had prior knee injuries, or who may not have sufficient tissue for grafting, an allograft might be a better choice.
In both grafting scenarios, the graft will be used to replace the ACL torn. A patella tendon autograft is a common choice, particularly in active patients. The patella tendon is the tendon that attaches the patella (the kneecap) to the tibia (the lower leg bone). This is a popular choice because the patellar tendon is large and strong, and bone can be taken out at each end of the tendon easily. The bone ends are then attached to the femur and tibia, allowing for strong, secure fixation and bone-to-bone healing.
There are other surgical graft options for autografts. One involves using the hamstring tendons (the semitendinosus and gracilis) and another involves using a portion of the quadriceps tendon taken from the quadriceps muscles. Dr. Millett will evaluate each patient to determine the best grafting option to use. In some instances, a cadaver graft (allograft) may be the best option to avoid additional morbidity to the knee.
There are many types of devices used to secure the graft to the bone. The graft is usually secured by screws and or buttons, the type of graft and the anatomic factors will determine the fixation technique.
Are you a candidate for ACL reconstruction?
There are two ways to initiate a consultation with Dr. Millett:
You can provide current X-rays and/or MRIs for a clinical case review ($250).
You can schedule an office consultation with Dr. Millett.
After Anterior Cruciate Ligament Repair Surgery
Anterior cruciate ligament surgery can be performed as an out-patient or in-patient procedure.
Arthroscopic anterior cruciate ligament repair surgery is typically performed by Dr. Millett as a one night hospital stay, although it can also be performed on an outpatient basis. Here are some things to remember about what to expect, as well as some helpful hints during the recovery process immediately following the procedure:
- After ACL reconstruction surgery, it is normal to have swelling and discomfort in the knee for several days following surgery. Apply ice bags or use the ice machine you were given to control swelling. Ice should be applied 20-30 minutes at a time, every hour or so. Be sure to protect your skin with a thin cloth. Icing is most important in the first 72 hours, although many people find that continuing it lessens their post-operative pain.
- In addition to general anesthesia, you will typically have had a nerve block during arthroscopic knee surgery. The local anesthetic may keep your leg numb for several hours. You will be given a prescription for pain medication when you are discharged from the hospital. If you find you do not tolerate it well, call our office and we will try another one.
- Keep the leg elevated. This will prevent swelling and help decrease pain. The leg must be elevated higher than the level of your heart.
- You will begin physical therapy rehab right away. Pumping your ankles up and down and squeezing your quadriceps can be helpful immediately. This should be done several times an hour to keep the blood circulating in your leg and to help prevent blood clots from forming.
- Keep the post-op dressing clean and dry. Unless it becomes wet or too tight because of swelling, leave the bandages in place for at least 2 days, then remove them. Cover the small incisions with waterproof bandages to keep them dry. You may shower, but keep the incisions dry for the first 10-14 days. Do not wet your incisions directly or by submerging (bathing or swimming) until at least 2 weeks post-op.
- The sutures are absorbable and do not need to be removed.
- Dr. Millett would like to see you back in the office 10-14 days after surgery. If you don’t have your first post-op visit scheduled, call our office ( 970-479-5871) to make one .
- Start your arthroscopic knee surgery post-operative rehabilitation/physical therapy right away. Your physical therapy program is key to a successful outcome. It should be started the day after surgery. A separate prescription will outline the protocol. It often helps to call before surgery to make an appointment with your physical therapist.
- Be in the care of a responsible adult.
- Abstain from drinking alcoholic beverages and from smoking as these behaviors can impact recovery and affect healing.
- You may eat a regular diet. Drink plenty of non-alcoholic, non-caffeinated fluids.
- Plan to take a few days off work.
Rehabilitation after ACL knee surgery can be a lengthy process involving a limitation of activities, physical therapy and rest that will need to take place for a period of months. Specific rehabilitation will vary according to each patient’s needs and you must adhere to your own protocol as established by Dr. Millett and your physical therapist. Please visit the ACL rehab manual on this website to learn more about the rehabilitation process following ACL reconstructive surgery. Typically patients are allowed to return to unrestricted activities 4-5 months after surgery.