ACL repair or reconstructive surgery is surgery on the anterior cruciate ligament (ACL), which runs on the front of the knee, crossing the posterior cruciate ligament (PCL) in an X shape. ACL reconstruction surgery uses a graft to replace the ligament. Typically, the grafts come from your own body and include tissue taken from the tendon of the kneecap, or one of the hamstring tendons. Other good choices include allograft tissue (donor tissue). On the other hand, ACL repair surgery sews the ends of the torn ligament back together.
Most ACL repair surgery is done by reconstructing the ACL, since reconstruction typically gives better results than repair surgery. Repair surgery generally is only used in the case of an avulsion fracture (a separation of the ligament and part of the bone from the rest of the bone). In this case, the bone fragment connected to the ACL is reattached to the bone. ACL repair surgery is done by making small incisions in the knee and inserting instruments through these incisions (arthroscopic surgery) or by creating a large incision in the knee (open surgery). In either case, regional or general anesthesia can be used. ACL surgery is typically done on an outpatient basis.
Who is a candidate?
Candidates for ACL surgery generally have a complete ACL tear or other knee injuries. Good candidates typically are active adults or children with closed growth plates that have symptoms of instability, including knee pain and a knee that gives way during daily activities. Patients typically have already tried nonsurgical management of knee pain and loss of function, but have seen little success.
Who is not a candidate?
Candidates who have a partially torn ACL, but no symptoms of pain/instability or no other combined knee injuries are not good candidates for ACL surgery. Additionally, children whose growth plates are still open or anyone with a severe illness or infection are not good candidates. Nonsurgical and less invasive treatments such as a hinged knee brace or physical therapy may help restore the stability of the knee and reduce pain.
Like other surgeries, ACL repairs require certain general surgery procedures such as preoperative blood testing, and cessation of smoking or use of pain relievers and anti-inflammatory drugs one week prior. You will likely be asked to stop eating or drinking the night before surgery.
Arthroscopic surgery is done on an outpatient basis, while more invasive surgery may require a multi-day hospital stay. Immediately after your procedure, your doctor will prescribe medication for pain relief, and possibly a blood thinner to lessen the risk of blood clots. In the first few days after surgery, keep your leg elevated and apply ice to relieve swelling and prevent further inflammation. Ensure your incisions are kept clean and dry, and follow your surgeon’s instructions in regards to bathing, changing the dressing, and follow-up visits.
You can expect to return to normal activities in 4 to 6 months. Most patients use crutches for the first few weeks to avoid excessive pressure on the joint. It will be necessary to undergo a formal physical therapy program or regimen of knee-strengthening exercises and make take several months to a year. Physical therapy and rehabilitation will help restore motion and strengthen your leg and knee muscles.
As with any surgery, there are risks of complications related to infection or adverse reactions to anesthesia. Other known complications include injury to nerves and blood vessels, blood clots, surgical scar area numbness, problems with the graft tendon (in the case of reconstructive surgery), or the need for additional revision surgery. Pain and swelling are normal and may persist even with physical therapy, limiting future participation in athletic activities that require use of the knee.
Average US cost
$11,500+ (not inclusive of physical therapy)