The anterior cruciate ligament or ACL is one of the most important ligaments in the knee. When it is torn, reconstructive surgery is often necessary to stabilize the knee. Our Beverly Hills orthopedic surgeons specialize in ACL reconstruction and ACL Repair.
Anatomy of the Knee
The knee is responsible for providing us movement in our legs, allowing us to bend, walk, run and jump. The Anterior Cruciate Ligament (ACL) is the ligament responsible for limiting the forward motion of the tibia bone (shinbone), which is a good thing. It helps prevent the femur from sliding backward on the tibia and the tibia sliding forward on the femur. The ACL makes up one side of the crisscrossing ligaments that sits in the front of the leg and is centered between the femur and tibia bone.
The four ligaments of the knee provide stability and connect the knee to the femur and tibia that join it above and below:
- Anterior cruciate ligament (ACL) – Stabilizes the tibia bone and prevents it from sliding forward on the femur, and the femur from sliding backward.
- Posterior cruciate ligament (PCL) – Prevents the femur from sliding forward onto the tibia.
- Medial collateral ligament (MCL) – Prevents the femur from sliding side to side.
- Lateral collateral ligament (LCL) – Provides same function as the MCL.
What Does an ACL Injury Feel Like?
If you tear your ACL, you may experience one or more of the following:
- Sudden and severe pain
- A popping sound
- Swelling of the knee
- The inability to put weight on the knee
- Increased forward movement of the shinbone
Diagnosing an ACL Injury
The first step of an ACL repair will be seeing your doctor for testing. They will check your medical history and will give you a physical exam. An orthopedic surgeon will be able to diagnose your knee issue by asking about your knee, your symptoms, and any other past knee injuries. They will check your knees for stability, strength, swelling, and range of motion. Stability tests typically involve a Lachman test which compares the level of looseness in your knee, and a pivot shift test.
They may recommend an X-ray to look for any fractures or bone fragments in the knee, or may order an MRI to identify an ACL tear. An MRI will give the doctor a clear picture of tearing in the ACL to give you an accurate diagnosis.
If you have complete tearing of the ACL, and you’re experiencing instability, pain and limited range of motion, your doctor will likely advise knee surgery for repair.
Candidates for ACL Surgery
ACL surgery to repair a torn ACL is a good option if you have suffered a complete ACL tear, or have additional knee injuries. Damage to the meniscus cartilage is common with knee injuries, affecting about half of ACL tears.
ACL reconstructive surgery might be a suitable option for you if:
- You are an active adult who participates in low and high demand sports
- Your growth plates are closed (you are not a child)
- You have instability in the knee, knee pain, or a knee that gives out during normal activities
- Physical therapy and rehab have not worked to correct the ACL tear, pain, and instability
ACL Injury Repairs
When one or more of these ligaments is torn, the knee buckles or gives way. ACL tears most often happen during contact sports in which there is a lot of jumping, sudden stops, and changes in direction. Soccer, football, tennis, gymnastics, downhill skiing and volleyball are sports where ACL tears are common. Landing from a jump incorrectly, pivoting with the foot firmly planted, suddenly slowing down and changing direction, and hits and collisions to the knee can also cause ACL tears.
Women are more likely to suffer from ACL tears than men who participate in the same sports and activities. Studies show that women tend to land jumps in a way that puts stress on the knee, and have stronger muscles at the front of their thigh in the quadriceps than they do in the back of the thigh, the hamstrings. Strong hamstrings help prevent the forward motion of the tibia which can put stress on the ACL.
Multiple tears in knee ligaments also leads to more repairs done in the affected knee. The treatment for ACL tears is reconstructive knee surgery.
When an ACL is torn, surgery is needed to repair the torn ligament. In the past, invasive surgeries were the only option. Today, many ACL reconstructive surgeries can be done arthroscopically with just a few small incisions.
Do All ACL Tears Require Surgery?
Partial ACL tears may be mended and strengthened with rest and rehabilitation exercises. Physical therapy can often be successful for those with partial ACL tears and no instability issues, with complete tears and no instability issues who also don’t participate in high demand sports, people who live sedentary lives, and children whose growth plates are still open.
Full ACL tears will most likely require surgery to regain the person’s ability to stop and change direction easily and to perform normal tasks like walking without instability issues. Sewing a torn ACL back together is not highly effective, so ACL reconstruction is done with substitute grafting of tendons. ACL tears are treatable with arthroscopic surgery, a minimally invasive procedure that helps active individuals get back to regular activities and sports in as little as 6-9 months following the injury.
Arthroscopic Knee Surgery
Arthroscopic knee surgery is a minimally invasive procedure. Arthroscopy involves small incisions in which the surgeon inserts a camera and tiny surgical tools to perform the operation. Scarring is minimized, and surgical recovery times are considerably shorter. To top it all off, minimally invasive arthroscopic surgery is often just as effective as traditional open surgical procedures. In addition to ACL reconstruction, arthroscopy can be used to fix broken bones and damaged ligaments in other joints of the body.
Arthroscopic knee surgery is commonly used for the following procedures:
- Reconstruction of a torn ACL
- Removal or repair of torn meniscal cartilage
- Trimming of torn pieces of articular cartilage
- Removal of loose fragments of bone or cartilage
- Feel, repair or remove damaged tissue
Knee arthroscopic surgery begins with three small incisions in the skin of the knee-joint area. A small instrument with a camera and a little light called an arthroscope is inserted into the incision that will allow the orthopedic surgeon to see the inside of the joint and the damaged anterior cruciate ligament. The other two incisions will be used for addition instruments that need to be placed inside the joint during surgery.
This type of knee surgery can be classified into minor and major procedures. In major knee operations, a dislocated knee may need to be realigned or grafting operations might be needed fix one or more ligaments. Most arthroscopic knee surgeries are performed in an out patient setting, such as La Peer surgical center, under a General Anesthesia, Spinal or Epidural, a regional block, or local anesthetic. Post-surgery, sterile dressings are placed over the incisions and a Brace Wrap is placed in the region surrounding the joint.
What Does ACL Reconstruction Entail?
ACL reconstruction surgery involves a graft to replace the torn ligament. Autographs involving parts of the patient’s body are the most commonly used forms, which usually come from the tendon of the kneecap (patellar), from the hamstring, or from the quadriceps tendon.
ACL reconstruction is typically done arthroscopically, which, as we described above, is minimally invasive and requires only a few small incisions into the knee. During the surgery, your surgeon will make several small cuts around the knee and clean out the inside of the knee using a sterile saline solution. From there, they will insert an arthroscope into one of the incisions and will be guided by the tiny camera on the end that projects images onto a screen. The surgeon will insert their tools into the other small incisions. They will drill small holes into the upper and lower leg bones where they come together at the knee. The holes form tunnels which the graft is anchored to. The surgeon will then make another small incision into the knee to take the replacement graft.
The graft tissue is pulled through the tunnels and secured with screws or staples. The incisions are then closed and the knee is bandaged.
ACL Surgery Recovery
Immediately after the surgery, your knee will be swollen and you may have numbness around the incisions. You can use ice to reduce swelling. Your doctor may prescribe pain medication to ease discomfort. In the days following ACL surgery, you need to keep your incisions clean and dry and watch for signs of infection.
ACL reconstruction recovery can take several months, and patients should progress gradually in their recoveries to avoid re-injuring their knees.
The ACL reconstruction recovery timeline begins immediately after surgery, with the primary goal of reducing swelling and preventing discomfort. The next few weeks of recovery will focus on regaining motion in the knee joint. This involves extending and flexing the knee. The next goal is to regain strength.
After about a month and a half to two months after surgery, patients can begin light jogging, bicycling or swimming. Sports that involve side-to-side movements or pivoting, like basketball or football, should not be attempted at this stage of the recovery until a few months later. Patients can progress to that stage of recovery by performing exercises designed to simulate those activities.
Athletes will be cleared to return to regular sporting activities only after being cleared by their orthopedic surgeon. When doing so, they might be advised to wear a knee brace. All told an ACL reconstructive surgery recovery could take eight months, a year, or two years depending on the severity of the tear.
Contact an Orthopedic Surgeon in Beverly Hills
La Peer Health Systems in Beverly Hills boast some of the country’s finest orthopedic surgeons and sports medicine doctors. We utilize the latest and most effective procedures when performing arthroscopic reconstructive surgeries on the anterior cruciate ligament. To schedule a consultation with one of our talented orthopedic surgeons in Beverly Hills, call (855) 360-9119 or fill out our contact form.
For more information please visit our Knee Surgery Center of Excellence website, dedicated 100% to knee surgery!