The operation of anterior cruciate ligament reconstruction is indicated for patients who have ruptured (or torn) their anterior cruciate ligament (ACL). This is a serious injury, which often occurs during sporting activities. ACL reconstruction is generally a very successful operation, but it is important to understand that the recovery can be prolonged.
Most young, active people who rupture their ACL will benefit from an ACL reconstruction. Traditionally this operation was only recommended for patients who had experienced symptomatic instability following an ACL tear. There is now increasing evidence that there is no reason to wait for symptomatic instability of the knee to develop before undergoing ACL reconstructive surgery. This is particularly so for those wishing to return sports involving a lot of running and twisting.
What to expect from an ACL reconstruction
The surgeon will discuss with the patient the risks as well as the benefits of ACL reconstruction. Even though an ACL reconstruction operation takes about 1 hour to perform, the full recovery from the procedure can take up to a year.
An ACL reconstruction is performed under a general or spinal anaesthetic. A physical examination of the knee is performed by the orthopaedic surgeon. This confirms the amount of laxity in the knee. An arthroscopy of the knee is then performed. This confirms the ACL tear and allows for assessment and treatment any other knee injuries.
An ACL reconstruction involves replacing the injured ACL with a graft. The most commonly used graft is the patient’s own hamstring tendons. Semitendinosus and gracilis are commonly harvested via a small incision over the front of the knee. These hamstring tendons are removed to be used as the graft. Graft choice will have been discussed prior to the surgery. Other graft options include the patient’s own patella tendon or quadriceps tendon. Donor tissue (allograft) is occasionally used, particularly in revision (or redo) surgeries.
During surgery, the graft is placed through bone tunnels in the femur and the tibia. The graft is fixed into the bone using devices such as an Endobutton, or screws. Sometimes, supplementary staples are placed into the tibia.
At the end of the procedure the small wounds are closed using sutures. Local anaesthetic is instilled. Dressings are placed on the skin and a bulky bandage is then applied.
LARS synthetic reconstructions available
LARS knee reconstruction with a synthetic ligament can also be used for acute or fresh ACL injuries. The risks as well as the benefits of all of these graft options are discussed prior to surgery.
Patients who have knee reconstruction surgery generally stay overnight in the hospital. They mobilise the following day with the help of the physiotherapy team. Crutches are usually used.
Resting and icing is particularly important for the first week to decrease swelling. Patients will be provided with a special ice bag prior to surgery to be used in hospital and at home after discharge. While in hospital, patients will be instructed on how to use the bag at home. The patient is encouraged to straighten (extend) the knee as much as possible. Weight bearing is generally allowed according to comfort levels.
Patients who have had an ACL reconstruction are reviewed at Knox Orthopaedic Group two weeks after surgery. Their wounds are then inspected and their physiotherapy program then starts to increase.
The speed of recovery from ACL reconstruction surgery depends on the graft choice and the other injuries to the knee. Recovery will take up to twelve months, particularly for a hamstring graft. Recovery from a patella tendon graft may be quicker than this, however the patella graft can cause problems with kneeling and with anterior knee pain.
Risks and Complications
As with all operations, complications can occur, but these are rare. The risks of ACL reconstruction or LARS knee reconstruction include the following:
- regional pain syndrome
- blood clots.
These are all uncommon and most patients recover from LARS knee reconstruction and standard ACL surgery without complication.
The surgeons at Knox Orthopaedic Group will inform you of the risks as well as the benefits of surgery prior to a decision to undertake any procedure. Regular reviews will be performed postoperatively until full recovery is achieved. Ongoing physiotherapy is very important to regain strength and movement and function in the knee and the leg.
There is always a small risk of re-rupture of the ACL graft, particularly if high-level sport is resumed. However, most patients who have ACL reconstructive surgery make a good recovery and are able to resume their sporting activities and exercise programs without restriction.