Anterior Cruciate Ligament (ACL) Surgery

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Anterior Cruciate Ligament (ACL) Surgery

Definition

Anterior cruciate ligament (ACL) repair is done to reconstruct the ACL in the knee after it is torn. Often, a graft made of tendon is used to reconstruct the torn ligament.

Anterior Cruciate Ligament Injury

Reasons for Procedure

ACL surgery is an elective procedure. This means that surgery is not always necessary; it may depend on your lifestyle and age.

Surgery may be recommended if you have:

A complete tear of the ACL
A high degree of joint instability
Injury to the knee that affects more than one ligament
A need to return to sports or other activities that require pivoting, turning, or sharp movements
No improvement with rehabilitative therapy

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

Infection
Excess bleeding
Blood clots
Reaction to anesthesia
The operation does not provide the desired improvement in function
Instability of the knee
Numbness or stiffness in the knee
Kneecap pain after surgery

Smoking may increase the risk of complications and slow healing.

What to Expect

Prior to Procedure

Your doctor may do the following:

Physical exam
Blood tests
Knee x-ray
MRI to see the internal structure of the knee

Before surgery, you will need to:

Arrange for help at home while you recover
Talk to your doctor about any medications, herbs, or supplements you are taking
Talk to your doctor about any allergies you have
Ask your doctor about assisted devices you will need

You may need to stop taking some medications up to one week before the surgery. Medications that may need to be stopped may include:

Aspirin or other anti-inflammatory drugs, such as ibuprofen or naproxen
Blood-thinning drugs, such as warfarin
Anti-platelet drugs, such as clopidogrel

Do not eat or drink anything after midnight the day before your surgery, unless told otherwise by your doctor.

Anesthesia

Anesthesia will block pain and keep you comfortable during the procedure. Anesthesia methods include:

General anesthesia is given through an IV. You will be asleep during the procedure.
Spinal anesthesia is given through the spine. The doctor may give you a sedative to keep you relaxed and ease anxiety.

Description of the Procedure

IVs will be placed in your arm or hands for medications and fluids. The doctor will examine the range of motion of the knee and confirm the ACL tear. Next, the doctor will locate another tendon in your knee or hamstring (called autograft) to reconstruct the torn ligament. Sometimes a donor graft (called allograft) is used. The doctor will form the graft tendon to the correct size.

One or two small keyhole incisions will be made on the top of the knee. An arthroscope (or endoscope) and tiny tools will be inserted into the knee joint. The torn ACL is removed and other damage to the knee is trimmed or repaired. In order to reconstruct the tendon, the doctor will drill holes through bone structures in the thigh and shin. The new graft will be placed through these holes. Needles may be threaded through the holes to suture the new tendon into place. Other devices, such as screws, washers, or staples are also used to hold the graft in place.

Once the graft is securely in place, the doctor will test the knee’s range of motion. Other tests will be done as well. The skin will be closed with stitches. Bandages and/or a brace will be placed on the knee.

How Long Will It Take?

About two hours.

How Much Will It Hurt?

Anesthesia will block pain during the procedure. You will have pain after the procedure. Ask your doctor about medication to help manage pain.

Average Hospital Stay

This procedure is done in a hospital setting. You can usually go home the same day. If you have complications, you may need to stay longer.

Post-procedure Care

At the Hospital

After the procedure, the hospital staff may provide the following care:

Monitor your vital signs as you recover from the anesthesia.
Medication to manage pain.
Antibiotics to prevent infection.
Medication that prevents blood clots.
Place ice packs on your knee.
Show you how to use a continuous passive motion machine.
Teach you how to use crutches or knee brace.

At Home

When you return home, take these steps:

Take pain medication as directed.
Use crutches or knee brace for as long as the doctor recommends.
Work with a physical therapist.
Gradually begin low impact activities, such as swimming or cycling, to strengthen the knee.
Keep the incision area clean and dry.
Ask your doctor about when it is safe to shower, bathe, or soak in water.
Be sure to follow your doctor’s instructions.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
Swelling, pain, or heat in your calves
Pain cannot be controlled with medications given
Nausea or vomiting
Cough, shortness of breath, or chest pain
Numbness in the knee area
Trouble urinating
New or worsening symptoms

If you think you have an emergency, call for medical help right away.

RESOURCES

American Academy of Orthopaedic Surgeons http://orthoinfo.org

American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

ACL Injury: Does It Require Surgery? American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00297. Updated September 2009. Accessed May 3, 2013.

Anterior cruciate ligament (ACL) injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 12, 2013. Accessed May 3, 2013.

Anterior cruciate ligament injuries. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00549. Updated March 2009. Accessed May 3, 2013.

Anterior cruciate ligament injuries: treatment and rehabilitation. Encyclopedia of Sports Medicine and Science website. Available at: http://sportsci.org/encyc/aclinj/aclinj.html. Accessed May 3, 2013.

Canadian Orthopaedic Foundation. Anterior cruciate ligament (ACL) surgery. Canadian Orthopaedic Foundation website. Available at: http://www.canorth.org/en/patienteducation/Default.aspx?pagename=Anterior%20Cruciate%20Ligament%20Repair. Accessed May 3, 2013.

Knee ligament repair. John Hopkins Medicine website. Available at. http://www.hopkinsmedicine.org/healthlibrary/test%5Fprocedures/orthopaedic/knee%5Fligament%5Frepair%5F92,P07675/. Accessed May 3, 2013.

6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Revision Information

Reviewer: John C. Keel, MD; Brian Randall, MD
Review Date: 05/2013 -
Update Date: 05/03/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Redmond Regional Medical Center