ACL Reconstruction Surgery

What is an ACL Surgery?

ACL, anterior cruciate ligament, surgery is a surgical procedure to repair an injured ligament in the knee. It is commonly referred to as ACL reconstruction, ACL repair or simply ACL surgery. Regardless of the name, the intended procedure is the same, with the goal of repairing the damage done to the ACL within the knee. As a major supporting ligament in the knee, the ACL is commonly injured and often done while performing sports or putting the knee through a strenuous twisting motion.

How do you prepare for an ACL Surgery?

Depending on the imaging of the knee, the severity of pain and/or it being a revision or not will affect the surgery. Sometimes before your surgery, you’ll likely undergo several weeks of physical therapy. Even with the intention of surgery, physical therapy can help prepare the knee leading up to it. The goals would be to reduce pain and swelling, restore your knees full range of motion, and strengthen muscles. People who go into surgery with a stiff, swollen knee may not regain full range of motion after surgery.

An ACL reconstruction is an outpatient procedure, so you’ll be able to go home the same day. You will need to arrange for someone to accompany you or drive you home. Make sure to tell your orthopedic surgeon about any medications or dietary supplements you take. If you regularly take aspirin or other blood-thinning medications, your surgeon may ask you to stop taking these types of drugs for at least a week before surgery to reduce your risk of bleeding. You will be given detailed instruction addressing questions around when to stop eating, drinking and taking any other medication the night before your surgery.

Why is an ACL Surgery performed?

In ACL reconstruction or repair, the torn ligament is removed and replaced with a piece of tendon from another part of your knee or from a deceased donor. Reinjury occurs in a small percentage of ACL surgeries requiring revision surgery. That is why it is important to see an orthopedic surgical specialist with extensive experience performing these. This surgery is an outpatient procedure that’s performed through small incisions around your knee joint.

An ACL reconstruction is generally recommended if:

  • You are an athlete or very athletic person. If you are looking to continue your profession or level of activity that involves heavy repetitive use of the knee you will want to repair the ACL.
  • Often times other supporting ligaments of the knee, such as the MCL, are injured with the ACL. If multiple ligaments are torn you will want to have them all repaired at once.
  • The injured knee is so weak that it is hindering normal everyday activities such as walking, using stairs or getting around.
  • You’re young (though other factors, such as activity level and knee instability, are more important than age)

What can you expect during an ACL Surgery?

An ACL reconstruction is commonly down under general anesthesia within an outpatient ASC (ambulatory surgery center). You will be very comfortable leading up to and during the procedure. The surgery is usually done through two small incisions. One allows a tiny, tube-like, camera called an arthroscope to be used to give a visual of the surgery. The other is for surgical instruments to perform the ligament repair.

An ACL surgery is simply broken down as:

  • Your surgeon will remove your damaged ligament, and then replace it with a segment of a tendon.
  • This replacement tissue is called a graft and it comes from another part of your knee or a tendon from a deceased donor.
  • Your surgeon will drill sockets or tunnels into your thigh bone and shinbone to accurately position the graft, which is then secured to your bones with screws or other fixation devices.
  • The graft will serve as the scaffolding on which new ligament tissue can grow.

What is the followup and recovery like for an ACL Surgery?

Once you recover from the anesthesia, you can go home later that same day. Before you go home, you’ll practice walking with crutches, and your surgeon may ask you to wear a knee brace or splint to help protect the graft.

Your doctor will give you specific instructions on how to control swelling and pain after surgery. In general, it’s important to keep your leg elevated, apply ice to your knee and rest as much as possible.

Medications to help with pain relief include over-the-counter drugs such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Your doctor might prescribe stronger medications, such as meloxicam (Mobic, Vivlodex, others) and gabapentin (Neurontin). If opioids are prescribed, they should be taken only for breakthrough pain as they have many side effects and a significant risk of addiction.

Follow your surgeon’s advice on when to ice your knee, how long to use crutches and when it’s safe to bear weight on your knee. You’ll also be instructed when you can shower or bathe when you should change dressings on the wound, and how to manage post-surgery care.

Progressive physical therapy after ACL surgery helps to strengthen the muscles around your knee and improve flexibility. A physical therapist will teach you how to do exercises that you will perform either with continued supervision or at home. Following the rehabilitation plan is important for proper healing and achieving the best possible outcomes.

What are the potential costs for an ACL Surgery?

ACL surgery is generally covered by most insurance plans. Please contact our office to make sure your benefits cover the procedure. Our staff will make sure to contact your insurance provider so we can clearly talk about any potential cost you may have to cover.

What are the potential risks for an ACL Surgery?

An ACL reconstruction is a surgical procedure. And, as with any surgery, bleeding and infection at the surgical site are potential risks. Other risks associated with ACL reconstruction include:

  • Knee pain or stiffness
  • Poor healing of the graft
  • Graft failure after returning to a sport

Are there related procedures to an ACL Surgery?

Commonly surrounding ligament injuries that need repairs such as the MCL, PCL, and LCL.



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Dr. William Lackey is the founder of Breakthrough Orthopedics, a New York based medical practice that specializes in minimally invasive surgical techniques and joint preservation procedures. Learn More »

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