Everything about ACL reconstruction

An ACL tear, short for anterior cruciate ligament tear, is a common injury primarily affecting the knee joint. It occurs when the anterior cruciate ligament, one of the major ligaments in the knee, is stretched or torn, often due to sudden twisting motions, abrupt stops, or direct impact to the knee.

This injury is prevalent among athletes participating in sports involving sudden changes in direction or pivoting movements, such as basketball, soccer, and football. Symptoms of an ACL tear typically include severe pain, swelling, instability in the knee joint, and a popping sensation at the time of injury.

An ACL tear can vary in severity, ranging from partial tears to complete ruptures. While some individuals may be able to resume normal activities with conservative treatment and rehabilitation, others may require surgical intervention, such as ACL reconstruction, to restore stability and function to the knee.

Prompt medical evaluation and appropriate management are crucial to minimize complications and facilitate optimal recovery from an ACL tear. Rehabilitation following treatment aims to strengthen the muscles around the knee joint, improve flexibility, and gradually reintroduce activities to regain mobility and function.

Steps of an ACL reconstruction procedure

• Preparing for surgery may involve preoperative tests, discussions with the surgical team, and consent forms.

• You’re administered general or regional anesthesia to ensure you are comfortable and pain-free during the procedure. 

• The surgeon makes small incisions around the knee to access the damaged ACL and surrounding structures.

• A graft, often taken from the patient's own tissue or a donor, is harvested. Common graft options include patellar tendon, hamstring tendon, or quadriceps tendon.

• The harvested graft is prepared by trimming it to the appropriate size and removing any excess tissue.

• Using specialized instruments, the surgeon creates bone tunnels in the tibia and femur to accommodate the graft.

• The graft is carefully threaded through the bone tunnels and secured in place using screws, buttons, or other fixation devices.

• The surgeon ensures that the graft is positioned correctly and appropriately tensioned to mimic the function of the natural ACL.

• The incisions are closed with sutures or surgical staples, and sterile dressings are applied to protect the surgical site.

• The staff monitors you in the recovery area and provides instructions for postoperative care, including pain management, rehabilitation exercises, and follow-up appointments.

Following ACL reconstruction surgery, a comprehensive rehabilitation program is essential to optimize recovery, regain strength and stability in the knee, and facilitate a safe return to sports and other activities.

ACL reconstruction risks

• Infection

• Bleeding

• Blood clots

• Graft failure

• Nerve or blood vessel damage

• Stiffness or limited range of motion

• Persistent pain

• Scar tissue formation

• Graft harvest site complications

• Failure to return to the previous level of activity

ACL reconstruction recovery

The recovery process after an ACL (anterior cruciate ligament) reconstruction procedure typically involves several stages and can vary depending on individual factors such as age, overall health, and the specific surgical technique used. Here's an overview of the general recovery process:

• Immediate Postoperative Period (Days 1-7):

  • Pain and discomfort are common immediately after surgery. Pain medications and ice therapy are often used to manage these symptoms. A knee brace or immobilizer may be worn to protect the surgical site and limit movement. Patients are encouraged to begin walking with the aid of crutches to prevent blood clots and promote circulation. Early range of motion exercises and gentle muscle activation exercises may be initiated under the guidance of a physical therapist.

• Early Rehabilitation (Weeks 1-6):

  • Physical therapy focuses on gradually increasing knee range of motion while protecting the healing graft. Progressive strengthening exercises target the muscles around the knee, including quadriceps, hamstrings, and calf muscles. Exercises to improve balance and proprioception (awareness of joint position) help restore stability to the knee. Walking without crutches and normalizing gait patterns is emphasized. Techniques such as massage and scar mobilization may be used to minimize scar tissue formation.

• Mid-stage Rehabilitation (Weeks 6-12):

  • Activities aimed at improving agility, coordination, and functional movement patterns are introduced. Specific exercises tailored to the demands of the patient's sport or activity are incorporated. Low-impact cardiovascular exercises such as cycling or swimming help improve endurance. With guidance from the healthcare team, patients may begin to reintroduce sports-specific drills and activities.

• Late-stage Rehabilitation (Months 3-6+):

  • The focus shifts to advanced strengthening exercises targeting sport-specific movements and power development. Training intensity and volume are gradually increased to prepare for a return to competitive sports. Regular reassessment of knee function and progress is conducted to ensure readiness for a return to full activity. Addressing any psychological barriers or concerns related to returning to sport is important for a successful recovery.

• Return to Sport (Months 6-12):

  • Clearance for a return to sport is typically granted by the surgeon and physical therapist based on objective criteria such as strength, stability, and functional performance. Continued sport-specific training and conditioning help optimize performance and reduce the risk of reinjury. Ongoing monitoring of knee function and maintenance of strength and flexibility is important to prevent recurrence of injury.

Throughout the recovery process, adherence to the prescribed rehabilitation program, regular follow-up appointments with your St. Luke’s Health orthopedic team, and open communication about progress and concerns are essential for achieving the best possible outcome following ACL reconstruction surgery.