Surgical Explanations
Rehabilitation Protocols
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ACL Reconstruction
The anterior cruciate ligament (ACL) is one of a pair of ligaments located deep in the center of the knee joint. The ACL, along with the posterior cruciate ligament (PCL), forms an x shape that connects the femur (thigh bone) with the tibia (shin bone). These two ligaments, along with the medial and lateral collateral ligaments on either side of the knee, help to provide stability to the knee as it flexes (bends) extends (straightens), and performs lateral (side to side) movement.
The ACL is usually torn when the knee is forced into a motion other than normal flexion or extension. The knee can hyperextend, or straighten beyond normal position; sometimes, the knee pivots or twists inward more than is normal. An injury can occur to the ACL during athletic pursuits but also during any activity that puts the knee into an abnormal position. Generally, patient’s experience a popping sensation followed by the feeling of instability. Many patients refer to their ACL deficient knee as a “trick knee,” as it can suddenly give way without warning.
Many people have ACL tears and are able to continue with all of their activities and require no treatment whatsoever. In fact, most people with ACL tears can still walk and jog without difficulties. People with ACL tears are usually not able to participate in activities that require the knee to pivot or twist quickly or change directions. These activities can include most sports like basketball, soccer, skiing, football, etc., and many work related duties. When the inability to use the knee for these activities becomes problematic, it is time to consider surgical intervention. Surgery cannot take place until swelling and inflammation decreases, so there may be some time between injury and actual surgical reconstruction.
An ACL reconstruction is a straightforward outpatient surgical procedure. Another ligament, either from your hamstring or patella (an autograft) or from a donor (an allograft), replaces the torn ACL. Dr. Bryan will discuss which type of graft is best for you. Dr. Bryan most commonly uses an allograft to replace the ACL. In this procedure, Dr. Bryan first looks into the knee with an arthroscope to assess the level of damage and also take care of any other abnormalities within the knee, such as meniscus tears. He then continues to reconstruct the ligament through the arthroscope. First, small tunnels are drilled at an angle from the tibia through the femur to mimic the angle at which the normal ACL connects the two bones. Then, the autograft or allograft ligament is pulled through the tunnel and secured at either end with bio-absorbale screws deep within the bone. By using the screws to secure the ligament, it creates a very stable joint that is able to bear weight as tolerated and allow the knee to go through its normal range of motion almost immediately.
All post-operative patients are placed in a hinged brace which will restrict some motion during the healing process. It is IMPERATIVE that ACL reconstruction patients begin physical therapy within a few days following surgery. For more details on the post-operative ACL reconstruction that Dr. Bryan recommends, please see the ACL rehab protocol on this website. |
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