The tissue used to create a new ACL is called a graft and can come from your body (an autograft) or from a donor (an allograft). An autograft is most often taken from the hamstring tendon or knee cap (patellar) tendon. The hamstring is the muscle at the back of the knee and thigh. An allograft comes from someone who, before death, chose to donate their body to help others.
Talk with your healthcare provider about benefits, risks, and alternatives to ACL reconstruction. Also ask about the time and effort it will take to recover. There are certain risks that come with any surgery, such as:
- Allergic reaction to anesthesia
- Breathing problems
Other risks specific to ACL surgery include:
- Blood clots in the leg
- The ligament does not heal
- The surgery does not relieve symptoms
Alternatives to ACL reconstruction include physical therapy and rehabilitation exercises, and knee braces.
Potential benefits include:
- Increased strength and stability in the knee
- Decreased pain
- Take some time off of work or arrange to work from home.
- Ask a responsible adult drive you to and from the surgery center and to stay with you at home for 24 hours.
- Arrange for help at home for the first few days after surgery.
- Make a list of all the medicines you are taking and bring it with you to the surgery center. Be sure to include all prescriptions, over-the-counter remedies (such as allergy pills or cough syrup), inhalers, patches, vitamin supplements, and herbal remedies.
- Follow all instructions from your surgical team about eating and drinking before your procedure.
Before surgery, an anesthesiologist will talk with you about pain control. You may have general anesthesia (you sleep through the procedure) or regional anesthesia (blocks feeling in your legs). The surgery is done by an orthopedic surgeon and usually takes between 60 and 90 minutes. The basic steps include:
- Making small incisions. For this type of surgery (called arthroscopy), the surgeon typically makes 3 or 4 small incisions (cuts) around the knee and inserts small instruments that will be used to make repairs. Sterile fluid may also be added to expand the area and make it easier to see and work on.
- Preparing for the graft. The surgeon takes out the damaged ACL. If you’re having an autograft, there will be another incision for removing replacement tissue (graft) from another part of your leg.
- Placing the graft. The surgeon drills small holes in your thigh and shin bones where the graft will be placed. Screws, stapes, or posts are used to help hold the graft in place. As it heals, the holes in the bone fill in and help keep the new ligament in place.
- Closing the wound. The surgeon will close the wound with sutures (stitches) or staples and cover it with a dressing.
After surgery, the surgeon will explain how the surgery went and what you should do at home. Since you may not remember all of this information, ask a friend or family member to take notes.
In the first days after surgery, expect to have a swollen leg and a thick dressing covering the surgical wounds. To care for yourself and your incisions:
- Take pain medicines as prescribed.
- Keep your leg raised above your heart for the first few days.
- Use ice to relieve pain and swelling.
- Keep your dressings clean and dry. Don’t shower, take a bath, go swimming or soak in a hot tub until your doctor says it’s okay.
- Wear compression stockings (T.E.D. hose) until your doctor says it’s okay to stop.
- Start your recovery exercises as soon as your doctor recommends.
- Use your assistive devices (crutches, brace, etc.) exactly as recommended to keep from injuring your knee.
- You may go back to work when your doctor says it’s okay. This is usually within one week.
- You can return to sports when your muscles are healed and you no longer have any swelling. Talk with your doctor before returning to sports.
Watch for problems, and call your doctor if you experience any of the following:
- Your knee keeps bleeding (small spots might show on the bandages, but they shouldn’t spread).
- You have pain that you cannot control.
- Pus or foul-smelling liquid drains from your knee.
- You have chills or a fever over 101° F (38° C).
- You have nausea and vomiting that does not stop.
- Your knee continues to swell or feel numb, and elevating your leg or loosening your bandage doesn’t help.
- Your foot or ankle starts to change color.
ACL (anterior cruciate ligament) reconstruction is surgery to replace a ligament in the center of the knee. A ligament is a strong band of tissue that connects one bone to another. The ACL is one of four ligaments that attach the thigh bone (femur) to the shin bone (tibia). The ACL keeps the shin bone in place and the knee from buckling (giving out) during physical activity. A damaged ACL will not heal on its own.
An ACL tear is a common knee injury, especially in people who do sports that involve high-speed turning, twisting, and jumping, high-speed stops, and blows to the knee. These commonly happen in sports such as soccer, basketball, football, and skiing.
ACL reconstruction may be recommended if:
- Your knee gives out or feels unstable during everyday activities.
- You have ongoing knee pain or other injured ligaments.
- You still have symptoms even after physical therapy and rehabilitation.
- Your job requires knee strength or you are very active in sports.
- You are willing to go through a long-term rehabilitation program.