ACL Resconstruction

What is ACL and its function in knee anatomy?

Ligaments are strong bands that connect bones to each other. Anterior cruciate ligament (ACL) is a band of connecting tissue which is located in the knee. Four ligaments in the knee are responsible for its stability, two of which are an Anterior Cruciate Ligament and a Posterior Cruciate Ligament. These two ligaments cross each other connecting the lower end of the femur with the upper part of the tibia. ACL is a key structure in the knee as its main function is to keep the knee stable preventing it from sliding backwards and rotating inwards.

What is ACL repair and how is it performed?

Performed arthroscopically

ACL reconstruction surgery typically lasts from 1 to 2 hours and is performed arthroscopically, meaning that only a few incisions are made for an insertion of an arthroscope and other surgical instruments.

Note: an Arthroscope is a small camera which helps the surgeon to see inside the knee.

Anesthesia

A patient will receive either spinal anesthesia, which numbs the body from the chest down, or general anesthesia, which puts the patient to sleep for the duration of the procedure.

Ligaments

In the beginning, the damaged ligament and its remains are removed and the knee is inspected for any other injuries or damage. A new ligament is then harvested from a tendon of the hamstring muscle – (remember that a tendon is a bone to muscle connection). It will be used as an ACL graft. Then the surgeon will create attachment points for the new graft by drilling a tunnel in the upper end of the femur bone, and another one in the lower end of the tibia. A graft is then pulled through those tunnels and secured in place with screws to create a new ACL ligament. During the recovery period bone growth will fill in the tunnels and will further stabilize the graft.

What indicates that you might need an ACL repair surgery?

If ligament is not treated it can lead to long-term pain. ACL is usually damaged because of quick turns and sharp movements during sports which require sudden moving out of one place to another, and sudden stopping (e.g. basketball, gymnastics, football, skiing). If a damaged ligament is not treated it can lead to long-term pain and instability of the knee.

When the ACL ligament is damaged, a person usually has trouble putting pressure on the knee when walking or when playing sports. A slightly torn ACL is likely to heal and regenerate over time, especially after doing physical therapy. Unfortunately, if it is fully ripped it might need to be replaced, particularly if a patient is young and actively participating in sports.

Some of the signs of a torn ACL ligament may include:

• A “popping” sound during a trauma event and swelling
• Pain which ultimately develops in the injured area of the knee
• Limited range of motion and instability when performing everyday tasks can also indicate the need for ACL repair

In order to further clarify if a patient actually requires surgical treatment a consultation with a specialist and evaluation of a CT scan or an MRI scan are needed.