Anterior Cruciate Ligament surgery (ACL) is a rupture fixing procedure, the torn knee ligament is replaced with the new one by taking tendons from another area of the knee joint. Chiefly, surgery is needed for boys or girls who are in sports.
When a person tears their ACL, they usually say that the “knee popped out” or the “bone moved.” Subsequently, the injured person develops a swollen, painful knee because the ligament bleeds when it tears and fills the knee with blood. Over a period of time, the blood disappears and the pain diminishes; the knee, however, remains unstable. The anterior cruciate ligament is a very important knee ligament for the stability of the knee.
It is basically a “cable” or “rope,” and a tear of this ligament usually causes significant instability of the knee. The aim of the ACL surgery is to put a full stop to the knee’s instability and to prevent knee pain and swelling. Once the knee becomes unstable as a result of ligamentous injury, the knee joint is much more prone to further injuries, such as tearing one or both of the cartilages (menisci) and the development of loose bodies or arthritis over a period of time.
Overall, the knee has a tendency to deteriorate significantly if it remains unstable and the initial ligament injury is not treated properly. Orthopedists estimate that only about twenty percent of people who tear their anterior cruciate ligament and do not have surgical treatment do well over the years. 80% percent of the people who tear their anterior cruciate ligament and who leave it untreated will develop significant secondary problems with their knee requiring various surgical procedures. Secondary problems include the development of torn cartilages, loose bodies, arthritis, or a painful knee. Women tend to do worse with an untreated anterior cruciate ligament injury than do men.
Who Are The Right Candidates For Surgery?
People with daily vigorous physical work are the right candidates for this, such as:
- Sports involve running or jumping such as cricket, soccer, and basketball
- Gym’s weight lifting trainers
- Overweight people
- Women with increased weight after pregnancy and menopause
When the leg twists while playing tearing of the knee’s ligament begins typically because of that.
How ACL Surgery Helps A Person?
If an athlete wishes to continue the career and he/she has a long road ahead then ACL helps to restore the stability. Also, when the knee pain is out of control ACL surgery helps. If the pain is more while doing even normal activities like standing and walking you can opt for this procedure.
What To Do Before The Acl Surgery?
The surgeon will arrange a consultation for the patient to ask the requirements, preference, and expectations from the ACL surgery also simultaneously, a knee examination will be performed. The surgeon will also make you understand the recovery process and physical therapy. Additionally, the surgeon will ask you about being comfortable with tendon removal.
During this time patient can ask questions like:
- Which graft is right for him/her?
- A total number of days in hospital after surgery.
- What are the potential complications of the surgery?
- From where the surgically implanted tendon will come from?
- Does the procedure demand fasting?
All these questions are very essential as surgery is going to be a bit crucial. Also, the surgeon will provide you a booklet in which everything regarding ACL will be written. Take a companion with you so that he/she can also know and ask about the surgery when you are busy with the check-up.
What Happens During The ACL Surgery?
At the time of surgery prior to reconstruction of the ligament, a complete diagnostic arthroscopy of the knee is performed. All other damage, including torn cartilages, bone chips, or any other problem within the knee, is repaired prior to ligament reconstruction. Through the use of arthroscopy, a new anterior cruciate ligament can be made for the knee and be placed within the knee joint without making a large cut on the knee. A two-inch skin incision and three arthroscopy cuts are used to perform this operation. The procedure allows the surgeon to make small, pleasing cosmetic incisions. Drill holes are placed within the bone, and the new ligament is held in place with dissolving screws. The surgeon and patient have a choice of the material used to reconstruct the anterior cruciate ligament.
The goal of the operation is to replace the torn ACL ligament, which is not repairable, with a new ligament made out of material that can last a lifetime. Human tissue is currently the only replacement tissue with the potential to last this long.
For a first-time reconstruction of the ACL, most orthopedic surgeons treating high-level and professional athletes recommend using the patient’s own tissues for reconstructing the ligament.
ACL Grafting: Bone-Patella Tendon-Bone (BPTB) vs Quadriceps Tendon
As of 2020, there are two options for reconstruction of the ACL in athletic individuals:
- Bone-patellar tendon-bone autograft (BPTB), or
- Quadriceps tendon autograft.
Autograft means using the tissue in your own leg and making that tissue into a new ACL ligament and placing it in the knee. Both grafts are large and extremely strong. The success rate of either procedure is excellent. However, BPTB is known in some patients to cause persistent pain in the front of the knee (anterior knee pain syndrome). This problem is not the case with quadriceps tendon grafts. For this reason, the surgeon typically switches to using quadriceps tendons. It also seems quad tendon patients have less pain and recover quicker than BPTB patients. Hamstring tendons are no longer used by most surgeons, as the results are not as good as with BPTB or quadriceps tendon grafts.
Cadaver Allograft (Using Deceased Donor Tissue)
Cadaver allograft for younger athletic individuals (under 25 years of age) generally should not be used, several studies have shown. Cadaver allograft (from a dead person) bone-patella tendon-bone graft is occasionally a choice to use for older individuals who are not that athletic and just desire some restoration of knee stability. It is also used for a failed ACL reconstruction in some cases as a second procedure. The arthroscopic technique for anterior cruciate ligament reconstruction allows this procedure to be performed as an outpatient procedure.
After The ACL Surgery
The doctor will keep you in the monitoring room for some hours to estimate the results and pain killers will be prescribed to you. You can go home either on the same day of the surgery or the next day if the operation is successful then. One requires the use of a cold compress to reduce pain and swelling. The next follow-up consultation will be declared by doc.
- You can use crutches or a walker
- Wraparound braces will be suggested by a doctor if the pain is mild but for severe pain hinged brace works
Expect wearing a brace for 7-10 days and crutches/walkers will be required for the next 2 -3 months. If you are a sportsperson then skip everything for the next 6 months at least and don’t indulge in intense and knee pressuring activities.
Recovery Of ACL Surgery
It generally takes six to nine months to fully rehabilitate the knee following ACL reconstruction surgery. High-velocity contact sports such as football, basketball, volleyball, or downhill skiing are usually allowed at 9 months following the surgery. This delay in time gives the new ligament a chance to develop a new blood supply and become strong.
- What are the risk factors involved with ACL surgery?
Just like other surgeries, ACL also comes with some risks, which include:
- Knee pain
- Tightness after the procedure
- Graft’s failure
- Blood clotting
- Infection and swelling
- Redness and pain
- Why is physical therapy needed for ACL surgery?
Physical therapy is necessary as it shortens the healing process and delivers the correct motion to the knee joint. The therapist generally divides exercises on a weekly or monthly basis. The exercise starts with some walking for 5-7 days, after a week towel calf stretch and tossing the crutches will be practiced this will continue for 2-3 weeks and in the fourth-week squats, side lunges and front/back lunges will be started. All these exercises give strength to the knee.
- What is the success rate of ACL surgery?
About 70-95% of people who have gone through ACL surgery tell that they have a tremendous amount of relief in pain and the ability to walk around is increased, more than 50% are women who need ACL.
- What’s the cost of ACL surgery?
The cost of ACL is around $1500-$45000 depending on the country, city, surgeon, duration, and equipment used, total appointments, and follow-ups.
- What’s the time of ACL surgery?
The procedure takes around 2 hours if any complications arise in between the procedure it may take 3 hours.
- What are the exercises one can do without ACL surgery?
There is a number of exercises which one can do reduce the pain without the surgery and that includes:
- Hamstring Curls
- Quad sets
- Calf raise
Make sure you are doing all these exercises correctly and under the licensed gym instructor’s guidance otherwise the reverse situations can occur which increases pain.