What Is ACL Surgery?

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The anterior cruciate ligament (ACL) is a strong band of connective tissue that runs diagonally through the centre of the knee, connecting the femur to the tibia. The ACL plays an important role in stabilising the knee joint, preventing excessive forward movement of the tibia and supporting rotational movements of the knee.

The ACL is composed of densely packed collagen fibres, which provide it with strength and stability. The ligament consists of two bundles: the anteromedial bundle controls rotational stability and limits internal rotation of the tibia and the posterolateral bundle contributes to restraining the anterior movement of the tibia.

Symptoms Of An ACL Tear

When the ACL is torn, it means that the ligament fibres have been stretched, partially torn, or completely ruptured. ACL tears are often the result of sudden twisting or pivoting movements or direct blows to the knee. Athletes involved in sports that require sudden stops changes in direction, or jumping are particularly prone to ACL injuries.

  • The knee joint may swell rapidly after an ACL tear, and the site might be painful, especially in the early stages.
  • It might be difficult to fully straighten or bend the knee, depending on the severity of the tear. 
  • The torn ACL is no longer able to adequately stabilise the knee joint. This can lead to a feeling of the knee "giving way" or feeling unstable during activities that require pivoting or jumping.
  • Activities that involve weight-bearing, such as walking, running, or participating in sports, can become challenging and uncomfortable.

Athletes may find it difficult to return to their previous level of performance without proper treatment and rehabilitation. ACL tears can often occur in combination with other knee injuries, such as damage to the menisci (cartilage pads) or collateral ligaments. These additional injuries can further affect knee stability and function.

Non-Surgical Treatment For ACL Tears

Non-surgical treatment for ACL injuries typically includes rehabilitation exercises such as physical therapy and functional training, bracing of the knee and activity modification.

Non-surgical treatment for ACL injuries may be recommended when the ACL is sprained or partially torn, and the knee remains stable. These treatment options may be suitable for individuals who have minimal symptoms, such as mild pain, and whose daily activities or sports participation does not require significant knee stability or involve high-demand pivoting movements.

Non-surgical treatment may not restore the knee to its pre-injury stability, and there is a higher risk of future episodes of knee instability and secondary injuries. Non-surgical interventions alone are not enough to heal a torn ACL. A fully torn ACL will not recover on its own. 

Pre-Operative Care For ACL Surgery

The patient will undergo a thorough medical evaluation before the surgery, which may include a physical examination, a review of medical history, and diagnostic tests such as X-rays or MRI scans. This evaluation helps determine the patient’s overall health status and identify any underlying medical conditions that may affect the surgical procedure or anaesthesia.

The surgeon or healthcare team will provide detailed information about the ACL surgery, including the risks, benefits, and expected outcomes.

The care team will also provide detailed instructions regarding pre-operative preparations. This may include guidelines on fasting (avoiding food and drink for a specific period before surgery), medication management (such as discontinuing certain medications that can interfere with the surgery or anaesthesia), and specific hygiene instructions (such as showering with a special antiseptic soap the night before or the morning of the surgery). 

In some cases, a separate consultation with an anesthesiologist may be necessary. The anesthesiologist will review the patient's medical history, discuss anaesthesia options (such as general anaesthesia or regional anaesthesia), and address any concerns or questions related to anaesthesia during the surgery.

Depending on the patient's condition and the surgeon's recommendation, pre-operative physical therapy may be prescribed. This can help improve the knee's range of motion, strengthen surrounding muscles, and optimise the knee's stability before surgery. Pre-operative physical therapy can also facilitate post-operative rehabilitation.

It is important for the patient to make certain lifestyle adjustments leading up to the surgery. This may involve avoiding activities that could further damage the knee or increase the risk of injury. It is also advisable to quit smoking, if applicable, as smoking can impair the healing process.

Patients may need to make certain preparations at home to ensure a comfortable recovery. This may involve arranging necessary medical equipment (such as crutches or a knee brace), creating a recovery space with easy access to essential items, and arranging for help with daily activities and transportation after the surgery.

What Happens During ACL Surgery?

ACL surgery is a type of orthopaedic surgery known as ACL reconstruction. The goal of ACL reconstruction is to restore stability and function, and prevent further damage to the knee joint. The surgery aims to allow individuals to return to their previous level of activity and reduce the risk of future knee instability.  

  • During ACL reconstruction, the torn ligament is reconstructed with a graft, which can be sourced from the patient's own tissue (autograft) or donor (allograft). The most common autograft options for ACL reconstruction include the patellar tendon, hamstring tendon, or quadriceps tendon.
  • The surgeon will select the appropriate graft based on the patient's age, activity level, and the surgeon's expertise. If an autograft is used, the surgeon will harvest the graft tissue, typically from the patellar tendon or hamstring tendons. The graft is then prepared to the appropriate size and length.
  • The surgeon will make small incisions in the knee to access the joint.
  • The torn ACL is carefully removed, and any associated damaged structures in the knee, such as meniscus tears, may also be repaired.
  • The surgeon will drill tunnels in the femur and tibia, representing the original attachment points of the ACL.
  • The prepared graft is then passed through these tunnels and fixed securely to the bones using screws, staples, or other fixation devices.
  • The surgeon repairs the soft tissue and skin with sutures and the patient is moved to a recovery room.

In many cases, ACL surgery is performed on an outpatient basis, meaning the patient can leave the hospital or surgical centre on the same day as the procedure. If there are complications or the surgeon deems it necessary, a short hospital stay of one or two nights may be recommended. 

Post-Operative Care For ACL Surgery

Pain management is a priority during the early stages of recovery. The surgeon may prescribe pain medication or recommend over-the-counter pain relievers to manage discomfort.

The surgeon may also prescribe other medications, such as anti-inflammatory drugs or blood thinners, to prevent blood clots and manage inflammation. It is important to take all medications as prescribed and attend all scheduled follow-up appointments for the surgeon to monitor the healing progress and make any necessary adjustments to the treatment plan.

Proper wound care is essential to prevent infection. The patient will be instructed on how to clean the incision site, change dressings, and keep the area dry and protected. It's important to follow the surgeon's guidelines and report any signs of infection, such as increased pain, redness or drainage. Swelling is common after ACL surgery. Applying ice packs to the knee and elevating the leg can help reduce swelling and discomfort. 

The knee may be immobilised using a knee brace or a splint to protect the surgical site. Initially, crutches or assistive devices may be used to limit weight-bearing on the surgical leg. Over time, as healing progresses, the patient will gradually increase weight bearing with the guidance of the surgeon and physical therapist.

The patient will typically undergo a structured rehabilitation program, guided by the physical therapist, to gradually regain strength, stability, and functional abilities.

The timeline for returning to specific activities will vary for each individual. Adhering to the post-operative care plan, including physical therapy exercises and lifestyle modifications, is essential for achieving the best possible outcome and long-term success after ACL surgery.

ACL Reconstruction Surgery

ACL reconstruction is a type of orthopaedic surgery performed to restore stability and function to the knee joint after an ACL tear. The surgery involves replacing the torn ligament with a graft sourced from the patient's own tissue or a donor. Non-surgical treatment for ACL tears may be recommended for partial tears or individuals with minimal symptoms and low-demand lifestyles. However, it's important to note that non-surgical treatment alone may not restore full knee stability, and surgical intervention is often necessary for optimal outcomes.

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