Anterior Cruciate Ligament (ACL) Surgery

Overview

Anterior cruciate ligament (ACL) surgery is a common orthopedic treatment performed to repair a torn ACL ligament. People who play sports that require pivoting and quick movements such as basketball or soccer are at greater risk of experiencing an ACL tear. While most patients experience a full recovery, the process can take nine to 12 months.

ACL surgery candidates

You may be a candidate for ACL surgery if your ACL tear is complete or if you have other knee injuries in addition to the ACL injury. Criteria your doctor may use to determine if you are a candidate for ACL surgery include:

• You are an adult who lives an active lifestyle.
• You are a child whose growth plates have closed.
• You have instability that gives away while participating in activities or sports.
• Nonsurgical therapies, such as physical therapy, have not been effective.
• You are an athlete who participates in a sport that involves jumping, cutting, or pivoting, and you want to continue playing your sport.
• More than one ligament has been damaged in the injury.

You may not be a candidate if:

• You have a partially torn ACL without any signs of instability or other knee injuries. Generally, nonsurgical therapies such as physical therapy are effective in these cases.
• You are a child with open growth plates.
• You have an infection or serious illness.

ACL surgery risks

While ACL surgery is generally a safe procedure, there are some risks associated with the surgery, including:

• While the chances of developing an infection are small, your doctor may give you an antibiotic before surgery to prevent an infection from developing
• Blood clot. Patients at risk of developing a blood clot may be given medications to prevent blood clots from forming.
• Knee pain. Approximately 20 percent of patients who have ACL surgery will experience residual pain.
• Weakness or stiffness in the knee.
• The new graft will fail, and the knee will remain unstable. This occurs in approximately 10 percent of patients. Your doctor will review your case and determine if a subsequent surgery may be effective.

ACL surgery preparation

Most patients will be required to undergo physical therapy before surgery to reduce pain and swelling as well as restore the knee’s range of motion. If you have surgery before you have a full range of motion in the knee, you may not return to full range of motion after surgery.

ACL surgery expectations

Your orthopedic surgeon will likely perform arthroscopic surgery to repair your ACL.

Advantages of ACL surgery include:

• Your doctor can easily work on the knee.
• The procedure uses smaller incisions than open surgery.
• In many cases, it is performed at the same time as a diagnostic arthroscopy procedure that is used to diagnose knee damage.
• Reduced chances of complications than open surgery.
• The procedure is performed under general or regional anesthesia.

During ACL surgery, your doctor will make a series of small incisions around the knee. To improve visibility, saline is injected into the knee to expand the area and clear blood from the damaged area.

Your doctor will insert an arthroscope with a camera on the end into an incision. The camera will send photos to a monitor in the operating room. Small surgical instruments will be inserted into an incision, and your surgeon will drill holes into the upper and lower leg bones. The tissue graft will be anchored through these holes. If your doctor is using your tissue, your doctor will take a tissue graft from another location in the knee. The doctor will secure the graft into place with screws and staples. Once your doctor has stitched or taped the incisions shut, you will be taken to a recovery room.

ACL surgery is performed under general anesthesia. You will be able to go home on the day of the surgery, so it is important to have a driver as you recover from the anesthesia.

Follow your doctor’s discharge instructions to control pain and reduce swelling. Ice and elevate the leg and rest as much as you can directly after the procedure.

It is essential to go to all your follow-up appointments so your doctor can track your recovery process and tweak if needed.

After ACL surgery

Your orthopedic surgeon will recommend physical therapy as an essential part of your recovery process. Over four to six months, you will gain strength and stability in your knee.

When patients follow their doctor’s recovery and rehabilitation instructions, most patients experience a full recovery after ACL surgery. Total recovery takes approximately nine months. For competitive athletes, you can expect to need eight to 12 months before returning to play.