Overview

What is Arthroscopic ACL Reconstruction?

Surgeons undertake arthroscopic surgery to treat the ACL, making it less invasive and thus allowing patients to recover quickly. In the reconstruction process, the damaged portion of the ligament is replaced by the tissue graft taken from another donor or your body part.

Who Should Have ACL Reconstruction Surgery?

Active adult patients with pivoting, turning or hard-cutting sports jobs or heavy manual work should also be considered for surgical treatment. This also means consideration in older patients who previously have been de-aider from consideration of ACL surgery. It is the activity level, not the age, that should determine whether surgery should be considered.

Indeed, early reconstruction of the ACL in young children or adolescents creates the potential risk of growth plate injury, which can lead to problems in the growth of the bone. However, most of the latest research favors early reconstruction of the ACL since delay in its treatment may increase the chances of further damage to the meniscus or cartilage even more.

A patient who has a torn ACL and considerable functional instability is likely to suffer damage to other regions of the knee and, therefore, he or she should be considered for ACL reconstruction.

Other injuries that commonly occur with ACL injuries are tears in the menisci, articular cartilage, collateral ligaments, the joint capsule or a combination of the above. The "unhappy triad," commonly found in footballers and skiers, involves tears of the ACL, the MCL, and the medial meniscus. Combined injuries can have indications for surgical intervention and generally result in better outcomes than non-operative management. Up to half of meniscus tears are potentially repairable; they also tend to heal better if repaired concomitantly with ACL reconstruction.

How does ACL reconstruction surgery work?

During ACL reconstruction surgery, an ACL is constructed using a graft of replacement tissue taken from one of the following two sources:

A portion of the patient's own iliotibial band, hamstring, quadriceps or patellar tendon
An allograft-an implant of tissue from a human organ donor

Type of graft used for each patient will be case-dependent, but allograft tissue is contraindicated in young patients because it confers a significantly increased risk of reinjury and graft failure.

The arthroscopic surgery to reconstruct the ACL is done by employing minimally invasive techniques, in which a combination of fiber optics, small incisions, and small instruments is used. However, slightly larger incision is needed to take out the tissue graft. ACL reconstruction is an ambulatory procedure; that is to say, the patient can be discharged home on the very same day of the surgery.

What are the potential surgical complications of the ACL reconstruction surgery?

Infection: The postoperative risk of infection after arthroscopic ACL reconstruction is low; however, improper procurement and sterilization techniques have led to reported deaths from bacterial infection by allograft tissue.
Viral transmission:Allograft are considered a risk for viral transmission, including HIV and Hepatitis C, even though they undergo extensive screening and processing, although the likelihood of an HIV infected donor providing a bone allograft is less than 1 in 1 million.
Risks: Bleeding, numbness. Rare risks include bleeding, leg weakness or paralysis of the foot and numbness near the incision, which may be temporary or permanent.
Blood clot: A blood clot in the calf or thigh veins is fatal; it may reach the lungs or brain, which can cause pulmonary embolism or stroke.
Instability: Chronic instability due to the rupture or tearing of the reconstructed ligament, or poor surgical technique, occurs in 5-10% of patients in the long term.
Stiffness: Patients having stiffness or loss of motion after surgery may require surgery, either by removal of scar tissue or manipulation of the knee under anesthetic.
Extensor mechanism failure: The patellar tendon might rupture, or the patella fracture, as a result of weakening at the harvested site where the graft was taken from.
Growth plate injury: Early ACL reconstruction in young children risks growth plate injury and problems with bone growth and might be necessary to delay until skeletal maturity can be anticipated to occur without intervention. Modifications may reduce injury risk.
Patellar pain: This is one of the most common post-operative anterior knee pains following patellar tendon auto graft ACL reconstruction, with kneeling pain often being more prevalent.

What is the recovery time for ACL surgery?

The overall expectation to return to sports after reconstruction of the ACL is typically within 9 to 12 months. However, this varies with competition level, type of activity, and speed of progress with PT.

They can walk with crutches and a leg brace on the day of surgery. The patient starts rehabilitation the second to third day post-operatively, gradually improving strength, stability, and range of motion in the knee. Rehabilitation is a series of exercises. Within the early stages of recovery:

The quadriceps muscle is strengthened and knee movements are activated as early as possible in the postoperative period.
Running exercises start around 3 to 5 months.
Pivoting exercises begin around 5 to 8 months.
Return to sport-specific activity can be quite sport-dependent. For example, for track and crew activities, athletes may return at three months. However, with activities like soccer or football, where they cut and pivot so much, it is more about nine months until return to practice and 12 months until return to competition.

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