ACL Surgery: Your Path Back to the Activities You Love

09 April,2024

The anterior cruciate ligament is one of the major knee ligaments that helps stabilize the joint. Unfortunately, ACL injuries are common, especially among athletes who play sports that involve quick changes in direction, jumping, or pivoting. 

It's essential to consider the emotional impact of an ACL injury. Suffering a significant knee injury can be distressing and frustrating, especially for athletes or individuals with an active lifestyle. The fear of a prolonged recovery and uncertainty about returning to normal activities can affect mental well-being. 

Proper education and knowledge about treatment can help improve disease-related anxiety and provide better outcomes. This blog aims to do just that. We will explore the symptoms, causes, preparation for surgery, different surgical techniques, postoperative care, and long-term outlook of ACL surgery.

What is ACL Surgery?

ACL surgery is the standard treatment modality for ACL injuries. ACL tears or injuries can be classified depending on their severity and the extent of damage to the ligament. 

• Partial ACL Tear: In a partial tear, only a portion of the ACL is damaged. The ligament remains intact, and the tear may not wholly disrupt its function.
• Complete ACL Tear: A complete ACL tear involves a rupture of the entire ligament, separating the ligament fibers.

Orthopedic surgeons manage ACL injuries, which can be managed by reconstruction or repair. ACL repair is an older technique that has been performed since the 1970s. It involves sewing the torn ligaments with sutures. In ACL reconstruction, the ligament is completely rebuilt with the help of grafts or tissues. It has better surgical outcomes and lower failure rates compared to ACL repair. 

With advancements in orthopedic medicine, surgeons now perform ACL surgeries using minimally invasive arthroscopic techniques. It has led to a significant reduction in postoperative complications and a quicker recovery.

What are the Different Types of Grafts Used for ACL Surgery?

ACL surgery usually involves reconstructing the torn ligament using a graft, which can be harvested from different sources. The two primary types of grafts used for ACL reconstruction are –

• Autografts: This procedure involves using a portion of the patient's own tissue, commonly from the hamstring or patellar tendons. It offers the power of using the patient's tissue, minimizing the risk of graft rejection. The hamstring autograft, for example, is known for its strength and low risk of complications. The patellar tendon autograft, on the other hand, is valued for its bone-to-bone healing and stability. 
• Allografts: This procedure uses tissue from a cadaver donor, eliminating the need for a second surgical site and reducing the risk of complications associated with graft harvesting. Allograft options include Achilles, hamstring, or patellar tendon from a donor.

The graft choice depends on various factors, including the surgeon's preference, the patient's age and activity level, and concurrent injuries. Discussing the different options with your surgeon will help determine the most suitable surgery for your situation. 

What are the Causes of ACL Injuries?

ACL injuries can happen to anyone, regardless of age or athletic ability. When the ACL is torn or ruptured, it can lead to instability and loss of function in the knee joint. ACL tear can make participating in activities requiring strong knee movements difficult. Common causes of ACL injuries are – 

• Sudden twisting or hyperextension of the knee. Soccer, basketball, football, and skiing are particularly prone to these injuries. 
• Non-contact injuries can also happen during everyday activities if the knee is forced into an unnatural position. 
• Furthermore, inadequate conditioning, improper landing techniques, and muscle imbalances may increase the risk of ACL injuries. 
• Weak muscles around the knee, particularly the quadriceps and hamstrings, can contribute to the likelihood of ACL tears. 
• Additionally, poor biomechanics, such as how an individual moves and lands during physical activities, can significantly predispose someone to ACL injuries.

Reducing the chances of ACL injuries

Understanding the risk factors and common causes associated with ACL injuries can help individuals take proactive steps to protect their knee health and overall well-being.

• Addressing these risk factors through proper training, including conditioning and strength exercises that target the muscles supporting the knee joint, is essential. 
• Engaging in activities that improve balance, agility, and proprioception can also help reduce the chances of sustaining an ACL injury. 

What are the Signs of a Torn ACL?

If you suspect an ACL injury, seeking prompt medical attention is crucial. An orthopedic expert will perform a physical examination, possibly combined with imaging tests like an MRI, to evaluate the grade of injury. Common signs and symptoms of ACL injury are – 

• Popping sensation in the knee
• Pain and swelling. 
• Unstable knee
• Difficulty bearing weight or walking normally
• Limited range of motion 
• Difficulty straightening the knee

Preparation for ACL Surgery

It's essential to have a detailed understanding of what to expect during ACL surgery. Before the procedure, your treating surgeon will provide specific preparation instructions, including fasting guidelines and medication usage.

• Stopping medications, such as antiplatelets, anticoagulants, and NSAIDs, is necessary before surgery. These include drugs such as naproxen, ibuprofen, and aspirin, which make it hard for the blood to clot, ultimately increasing the chances of bleeding.
• Inform your treating surgeon about any medical conditions you have, such as diabetes, hypertension, hyperlipidemia, etc.
• Stop smoking and drinking alcoholic beverages for a few days before the surgery to reduce the chances of postop complications.
• On the day of the surgery, you may need to undergo additional pre-operative tests and consultations with the medical team. It's essential to follow any pre-operative protocols to ensure a successful surgery.
• You will sign consent forms acknowledging that you understand the surgery's risks and benefits. It is standard procedure in healthcare to ensure that patients are aware of the consequences of the surgical intervention they are about to undergo. 
• You will meet the anesthesiologist before the surgery. They will discuss the anesthesia type that will be administered during the procedure. The anesthesiologist will explain the anesthesia's effects and address any concerns you may have regarding its use. 
• Your surgeon will be available to answer any last-minute questions or concerns you may have before being taken into the operating room.

How is ACL Surgery Performed?

ACL (Anterior Cruciate Ligament) reconstruction surgery involves repairing a torn or damaged ACL, a major ligament in the knee. The surgeon conducts a thorough examination, reviewing the patient's medical history and performing physical assessments. Diagnostic tools such as MRI scans assist the surgeon in assessing the extent of ACL damage and planning the surgery. The steps in ACL reconstruction surgery include:

• The patient receives general anesthesia to ensure they are unconscious and pain-free during the surgery.
• The orthopedic surgeon makes tiny incisions around the knee and inserts a small camera (an arthroscope) through one incision to visualize the knee's interior on a monitor.
• After carefully removing the torn ACL, the surgeon selects a graft, commonly from the patient's own hamstring or patellar tendon or occasionally from a donor (allograft). The chosen graft is prepared for insertion.
• Small tunnels are drilled in the tibia and femur to position the graft.
• Threading the graft through the tunnels effectively replaces the damaged ACL.
• The graft is then fixed in place using screws or other fixation devices.
• The surgeon assesses the knee's stability to ensure correct graft placement.
• After closing the small incisions with sutures or staples, the patient is moved to a recovery room for monitoring.

What Happens After an ACL Surgery?

A rehabilitation program is crucial for a successful recovery after ACL surgery. The process typically begins immediately after the surgery and continues for several months, gradually progressing from basic exercises to advanced activities.

• Rehabilitation focuses on minimizing pain and swelling, restoring the full range of motion, and rebuilding strength and stability in the knee joint.
• Physical therapy, such as exercises for strengthening the quadriceps, stretching hamstrings, and balance training, is vital in recovery. Your orthopedic surgeon and physical therapist will collaborate to develop a personalized rehabilitation plan for you.

Recovery timeline after ACL surgery

• On the same day of surgery, the patients can walk with walking aids and a leg brace. After that, they enter a rehabilitation program. 
• Running is allowed after four months, and pivoting exercises are permitted after five months. 
• ACL surgery patients can expect to return to their sports activities after six months of rehab and physical therapies.
• A full recovery can take anywhere from 6-9 months, depending on the degree of injury, the type of surgery, and the patient's compliance.

What are the Long-Term Outcomes of ACL Surgery?

The long-term outlook for individuals who undergo ACL surgery is generally positive. Patients experience remarkable improvement in knee stability and return to their previous activities, including sports, within approximately six to twelve months post-surgery.

A rehabilitation program is crucial in recovering from a torn ACL. Physical therapy sessions are recommended to restore range of motion, improve flexibility, and strengthen the knee muscles.

Furthermore, advancements in surgical techniques have improved ACL reconstruction outcomes. Orthopedic surgeons now have access to minimally invasive procedures, specialized graft options, and enhanced imaging tools, allowing for more precise graft placement and better preservation of surrounding tissues.

How to Improve the Outcomes of ACL Surgery?

• Follow the rehabilitation program diligently to ensure a successful outcome. 
• Consistency and dedication to the exercises prescribed by your physical therapist are crucial to regaining full knee function. 
• Staying motivated and having a positive attitude significantly improves your recovery.
• A well-balanced diet with plenty of minerals, vitamins, and other nutrients can aid tissue repair and muscle recovery.
• Adequate hydration is vital for general health and optimal performance during physical therapy sessions.

What is the Success Rate of ACL Surgery?

It's important to note that the success of ACL surgery depends on various factors, such as the extent of the initial injury, surgical technique, adherence to rehabilitation protocols, and individual healing response. 

On average, ACL surgery has a success rate of 80 to 95% when performed by a skilled orthopedic surgeon at a well-equipped hospital.

While most individuals can expect to regain normal function, some may experience residual symptoms or be at risk of developing arthritis in the knee. However, these complications are uncommon and occur in about 10% of people.

To Conclude

In conclusion, ACL surgery is a standard procedure for managing injuries to the anterior cruciate ligament. Knowing the symptoms, causes, and treatment options available can help individuals make informed decisions. By following proper pre-operative preparation, choosing appropriate surgical techniques, engaging in post-operative rehabilitation, and maintaining realistic expectations, individuals can maximize their chances for a successful recovery and long-term knee health.