ANTERIOR CRUCIATE LIGAMENT (ACL) TEAR
Going to the doctor can be a difficult and emotional experience. This is even more stressful when potential surgery is a consideration. Hopefully the information listed below can alleviate some of the stress and answer any questions that may arise.
What is wrong with my knees?
When you injured your knee, you tore one of the main ligaments which provides stability to the knee, the anterior cruciate ligament (ACL). Without the ACL, the knee will be unstable and give way if any side stepping, running or cutting motions are attempted. When your knee was injured, you may have damaged some of the cartilage and/or the menisci in the knee as well.
What is a ligament?
A ligament is a cord-like structure that connects two bones together at a joint and allows motion while providing stability. Stability refers to the joint moving in the proper plane while maintaining close apposition of the joint surfaces. When a ligament is torn, stability is compromised and the joint surfaces do not maintain this apposition and the bones can slide inappropriately on one another. This inappropriate motion can cause further damage to the cartilage and menisci.
What is cartilage?
Cartilage is the smooth white material that covers the ends of our bones in the joints. It provides a slick surface and allows the bones to glide over each other.
What are menisci?
Menisci are another form of cartilage that look like bumpers between the bones. Their purpose is to provide cushion between the bones and disperse contact pressures over a greater area.
A physiologically young person who wishes to remain active will have a difficult time without a functioning Anterior Cruciate Ligament. The knee will likely be unstable and suffer “giving way” or “buckling” episodes. During these episodes, the femur(thigh bone) and the tibia(leg bone) slide across each other and potentially cause new or further damage to the cartilage and menisci. For this reason, I recommend that you have surgery to correct the problem.
What is the goal of the surgery?
The goal of the surgery is to create a new ACL that will prevent the “giving way” or “buckling” episodes, and, hopefully prevent any further damage to the articular cartilage and menisci.
How is the surgery performed?
The ACL cannot be repaired because it is destroyed when it tears. Therefore, I make a new ACL using tissue that I take from somewhere else. This tissue can be from the patellar tendon in the front of your knee, your hamstring tendons, or allograft (donor) tissue.
What if I have persistent buckling episodes and do not have surgery?
Based on current medical knowledge, the likelihood of causing further damage to the knee and subsequently early onset of arthritis is very high.
Can I wear a brace instead of having surgery?
Although brace construction has come a long way, the best brace cannot substitute for a functioning ACL. Studies indicate that braces may prevent instability episodes at low loads(ie. Walking), but at higher physiologic loads (ie. Cutting or pivoting) they cannot.
What is surgery like?
The surgery is done via arthroscopic-assisted technique. That means that although all of the work inside your joint is performed through three 1⁄2” incisions, the graft is harvested through an approximately 1 to 3 inch incision.
Will torn cartilage and menisci be taken care of during the surgery?
Yes, torn cartilage and menisci will either be debrided or repaired at the time of the surgery. Menisci are very important to the normal function of your knee so I am very aggressive in attempting to repair them if it is at all possible. If one of your menisci require repair, an additional 2-3inch incision may be necessary on the inside or outside of your knee.
How long will surgery take?
Depending on how much other damage is encountered in your knee, the surgery will take around two hours.
How long will you stay in the hospital?
Patients enter the hospital in the morning, have surgery and go home the same day. This is called outpatient surgery.
How successful is the surgery?
This type of surgery is successful about 90-95%of the time. No operation is 100% successful in every patient, but the procedures we perform are reliable and will help restore your knee’s function. The success of your operation depends on many factors including:
- The amount of damage to the other structures in the knee
- Your body’s response to the injury and surgery
- Your compliance with post-operative rehabilitation
What are the potential complications of surgery?
Surgery is a complex and delicate process designed to repair damage structures deep within the human body. Complications can occur, but fortunately are rare. Infection can occur (<1%) and may require antibiotics and surgery to clean out the joint. Injury to peripheral nerves can also occur but are also uncommon (<1%). Most often the injury is a stretch injury due to manipulation of the extremity during surgery or compression by the tourniquet. These are usually temporary and resolve by 2-6 weeks. Permanent injury can occur but is exceedingly rare. A small nerve that supplies sensation to the outside part of the leg just below the knee is almost always sacrificed during the graft harvesting. This may leave you with a small area of “numbness” on the front of your leg.
When can I return to routine activities of daily living?
As soon as you are comfortable, I encourage you to be up and moving around. By the first or second post-operative day, I expect that you will move easily around your house with crutches and possible venture outdoors. As soon as you have recovered adequete quadriceps strength to support your weight without difficulty, I would like you to discard the crutches. There are particular circumstances where you will require a brace for a period of time, and I will let you know if that is the case.
When can I return to work?
For most sedentery jobs, I recommend a week off work. When you return to work your knee will be sore but you should be able to manage as long as you do no prolonged standing or walking. You will be on “light-duty” for 4 to 6 months depending on your work demands. These are merely guidelines and may need to be altered based on your individual recovery.
How is my knee rehabilitated?
You can perform many of the necessary exercises by yourself at home. However, I ask that you work very closely with the physical therapist and plan on going to therapy 2-3 times per week for at least the first 2 or 3 months. After that time period your need for closely monitored PT will depend on your anticipated demand that you will place on the knee.
What if I have more questions?
I encourage you to return to the office for further discussion at any time. You can also contact us.