ACL, or anterior cruciate ligament, reconstruction surgery is a procedure in which the injured ACL is removed and replaced with another piece of tendon taken from the same patient or from a donor. This procedure can be performed using open surgery, in which a large incision is made in the knee, or increasingly by modern keyhole surgery techniques, leading to a more rapid recovery and fewer complications.
ACL Grafts
The grafted tendon is most frequently taken from the patellar region of the knee or the hamstring at the back of the leg from the same patient in a procedure referred to as autograft. Tissue taken from another donor for use in this procedure is referred to as allograft, although this type of surgery is used less frequently due to problems with tissue rejection, according to an April 2007 article published in the American Journal of Sports Medicine.
Benefits of Keyhole Surgery
Keyhole surgery is particularly amenable to ACL repair, because structures in the knee are readily accessible and easily visualized with these techniques. Healing rates are much quicker than with open surgery techniques, with fewer postoperative complications, such as infection and clotting. Patients seldom require overnight hospitalization, further reducing costs and increasing convenience for the patient, according to a January 2000 article published in the American Journal of Sports Medicine.
Keyhole Surgery
Two or three small incisions are made around the knee, and sterile salt solution is pumped in to remove blood, clearing the field of vision. A specialized instrument containing a camera is inserted through an incision, allowing structures inside the knee to be visualized on a monitor. Surgical drills are then inserted through another incision and used to bore holes in the upper and lower leg bones, known as the tibia and femur, at the point these bones meet at the knee joint, according to a September 2010 article published in Knee Surgery Sports Traumatology.
Securing the Tendon
The grafted tendon often has small pieces of bone at either end, which can be fitted into the newly drilled holes, anchoring the tendon to the leg bones. The surgeon then secures the graft in place with screws or staples and closes the incisions with stitches or surgical tape, according to Knee Surgery Sports Traumatology.
Recovery
The rate of recovery after ACL surgery varies from patient to patient but typically ranges from four to six months. Ninety to 95 percent of patients who undertake an intensive physical therapy program throughout the recovery process achieve a good recovery, in which they have a full range of pain-free movement, and can resume sporting activities that were previously impossible with the damaged ligament, according to the Yorkshire Knee Clinic.
References
- American Journal of Sports Medicine: Current Trends in Anterior Cruciate Ligament Reconstruction: Part II Operative Procedures and Clinical Correlations
- Knee Surgery Sports Traumatology: Anterior Cruciate Ligament Reconstruction With Bone-hamstring-bone Hybrid Procedure
- American Journal of Sports Therapy: A 10-year Comparison of Anterior Cruciate Ligament Reconstructions with Hamstring Tendon and Patellar Tendon Autograft: A Controlled, Prospective Trial
- Yorkshire Knee Clinic: ACL Injuries
