Anterior Cruciate Ligament (ACL) Repair
Synonym: ACL Repair, ACL Reconstruction, Anterior Cruciate Ligament Reconstruction, Knee Ligament Repair, Knee Reconstruction
What is Anterior Cruciate Ligament (ACL)?
The Anterior Cruciate Ligament (ACL) is one of the most important and strong ligaments connecting the bones of the knee joint (from inside) i.e. the thigh bone (femur)
to the leg bones (tibia and fibula). The function of the Anterior Cruciate Ligament is to provide stability to the knee and minimize stress across the knee joint.
The name, cruciate means cross, and crucial. The cruciate ligaments not only lie inside the knee joint, they crisscross each other
to form an "x". The cruciate ligament located toward the front of the knee is the Anterior Cruciate Ligament (ACL), and the one located toward the rear of the
knee is called the Posterior Cruciate Ligament (PCL). Anterior Cruciate Ligament restricts excessive forward movement of the lower leg bone in relation
to the thigh bone and limits the rotational movements of the knee.
Where can I get Anterior Cruciate Ligament Repair?
Cost of procedure performed in the US: $17,000
All prices are in US dollars and include the cost of the procedure and minimum hospital stay. Estimates and minimum hospital stay will vary depending upon individual needs and requirements.
How is Anterior Cruciate Ligament injured?
Anterior Cruciate Ligament is the most common sports or fitness activity related injury and results from overstretching of this ligament within the knee. It is commonly
observed that women are more prone to Anterior Cruciate Ligament injury as compared to men which may be due to differences in anatomy, hormones, strength or conditioning.
How is torn Anterior Cruciate Ligament Diagnosed?
The diagnosis of Anterior Cruciate Ligament tear is based on:
- Physical examination
- Lachman's Test - This test is performed with the knee bent to 30 degrees, your doctor will gently pull on the tibia to check the forward motion of the lower leg in relation to the upper leg. A normal knee will have less than 2 - 4 mm of forward movement, with a firm stopping felt when no further movement is observed.
In contrast, a knee with an Anterior Cruciate Ligament tear will have increased forward motion and a soft end feel at the end of the movement. This is because of the loss of restraint
of the forward movement of tibia due to the torn Anterior Cruciate Ligament.
- Anterior Drawer Test - This is similar to Lachman's test, the only difference being that the leg is bent at 90 degrees.
- X-ray evaluation - X-ray films are evaluated for any possible tearing away of bone where the Anterior Cruciate Ligament attaches. Also, the x-ray will show any loose bone fragments
- Magnetic Resonance Imaging (MRI) - MRI is a non-invasive test that produces an image of all parts of the knee.
In this test, you will lie in a hollow cylinder while powerful magnets create signals from inside the knee which are then converted into a computer
image that clearly shows any damage to the structures inside the joint. The images are valuable not only to determine the presence of an Anterior Cruciate Ligament tear, but also to assess the degree of the tear along with any damage to related structures, such as the meniscus and other ligaments.
What does the procedure for Anterior Cruciate Ligament repair involve?
The procedure of Anterior Cruciate Ligament (ACL) repair is rather a 'reconstruction' procedure.This reconstruction procedure involves
substituting (grafting) a new ligament for the damaged one. Using tendons from other parts of the body as a substitute for the Anterior Cruciate Ligament was found to be
the most effective way of reconstructing the torn Anterior Cruciate Ligament. Currently, the two most popular methods in use are using part of the patella
tendon (Patellar tendon graft procedure), using a hamstring muscle tendon (Hamstring graft procedure) or using the tissue from a cadaver or deceased person
(Allograft procedure). The reconstruction of Anterior Cruciate Ligament is commonly performed using an Arthroscope as an outpatient
procedure. However, many doctors prefer to keep patients overnight in the hospital following surgery. Typically, an Anterior Cruciate Ligament reconstruction takes
2 - 3 hours. General anesthesia or a spinal anesthesia may be used. General anesthesia would allow you to be asleep
through the entire procedure. Spinal anesthesia involves an injection in your back that numbs only the lower body. A medication is also administered
with a spinal anesthesia to keep you sedated throughout the procedure.
How do I prepare for the Anterior Cruciate Ligament repair?
Make sure that you do not eat for anything for at least 8 - 10 hours before the Anterior Cruciate Ligament reconstruction procedure.
Routine pre-operative tests like blood tests, urine tests, chest x-ray, and an EKG will be performed. Leg measurements will be recorded to order a knee brace
which will be part of your rehabilitation program. Make sure to tell your doctor about all the prescription and non-prescription medications (including vitamin, mineral and herbal supplements)
that you might be taking. Also make a note of any drug or food allergies that you might have.
What to expect during the recovery period following Anterior Cruciate Ligament repair?
The recovery period following Anterior Cruciate Ligament repair comprises of::
- Phase I (Immediate post-operative period) - Before going to the recovery room, your knee will be bandaged, braced and
elevated and ice will be applied to reduce swelling. You will spend 2 - 3 hours in the recovery room before you are allowed to go home. You will be provided crutch training and educated
regarding control of pain and swelling as well as care of the incisions. Sometimes, a brace that prevents all bending movements may be
recommended. You will work with a trained physical therapist a few times a week at first, then once every week or two as you progress. On days when you
don't have a therapy session, you exercise at home for 30 to 60 minutes a day. In addition to strengthening exercises, you begin with balance training and stability exercise.
- Phase II (At Home) - Once at home, you will be instructed to get plenty of rest and get off your feet periodically. To avoid excessive post-operative swelling and pain,
keep your knee elevated by resting it on pillows. Pain and swelling can be controlled by placing ice packs around your knee. A compression wrap around your knee
is beneficial to control the swelling.
- Phase II (Rehabilitation) - The rehabilitation phase lasts several months after the Anterior Cruciate Ligament repair and consists of full return to activity without the help of a brace.
This would require full range of movement, normal muscle strength, absence of pain and swelling.
The grafted ligament eventually becomes as strong as or even stronger than the original Anterior Cruciate Ligament.
After post-operative rehabilitation, you should be able to participate in sports without the use of a brace and experience no episodes of instability
in which the knee gives way.
What is the outcome of Anterior Cruciate Ligament repair?
The rehabilitation program following Anterior Cruciate Ligament repair is very important and has a significant impact on the outcome of the knee stability.
For most individuals, Anterior Cruciate Ligament reconstruction can restore stability to the knee and will allow them to return to work and vigorous athletic activities
usually without any compromises.
B . R . A . N . D . of Anterior Cruciate Ligament Repair
Benefits of Anterior Cruciate Ligament Repair
- The goal of Anterior Cruciate Ligament repair is to stabilize the knee enough to suit your lifestyle and to reduce the likelihood of further damage to the knee.
- Treating Anterior Cruciate Ligament injuries may also help to reduce pain, prevent osteoarthritis, and prevent loss of strength and decreased movement in the knee.
- Successful reconstruction of Anterior Cruciate Ligament followed by postoperative rehabilitation should enable you to participate in sports without the use of a
brace and experience no episodes of instability in which the knee gives way, thus allowing you to return to full activities with a healthy knee.
Risks of Anterior Cruciate Ligament Repair
Like all surgical procedures, Anterior Cruciate Ligament repair has possible risks and chances of post-operative complications. They include:
- Risks associated with anesthesia
- Deep Venous Thrombosis (DVT) - This occurs when blood clots form in the deep veins of the leg which may cause the leg to swell, become painful
and warm to the touch.
- Infection - Proper care of the surgical incisions is very important to prevent this serious complication.
- Stiffness - Excessive scarring inside the knee joint after Anterior Cruciate Ligament repair can lead to an increasingly stiff knee. This can be prevented
by physical therapy which is begun shortly after the surgery.
- Although rare, newly placed graft may press against the bone as the knee bends or straightens, and restricts the normal movement of the knee.
Alternatives to Anterior Cruciate Ligament Repair
- Lifestyle change - Avoiding activities like jumping and playing sports like basketball, football or soccer where sudden slowing down and stopping is required
can prevent further damage to your knee
- Physical Therapy - The goal of physical therapy is to strengthen the muscles around your knee to compensate for the absence of intact Anterior Cruciate Ligament.
- Knee brace - These are custom made and can help stabilize your knee while participating in some of the sports activities.
Now or Never
- Treating injuries of Anterior Cruciate Ligament can prevent osteoarthritis and loss of strength of knee. Arthroscopic procedure for ACL reconstruction has made it possible as it is minimally invasive,
can be performed on an out-patient basis, there is shorter duration of anesthesia, quick recovery and faster return to your normal level of activities.
Decision to have Anterior Cruciate Ligament Repair
- The ultimate decision is yours! It is prudent that you decide to have surgical repair of Anterior Cruciate Ligament if the instability of your knee is severe, and the knee is constantly buckling. Surgical reconstruction of Anterior Cruciate Ligament is intended to prevent further damage to the knee and stop the daily discomfort of the knee giving way.
- If you choose not to have surgery for Anterior Cruciate Ligament repair, this does not mean that you have to go without any treatment at all. There is a rehabilitation treatment program which can be followed. This rehabilitation program emphasizes strengthening the leg muscles and learning to better control the knee and to avoid those situations most likely to cause instability of your knee.
Your Questions Answered on Anterior Cruciate Ligament Repair
B.R.A.N.D. of Anterior Cruciate Ligament Repair
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