Anterior Cruciate Ligament (ACL) surgery involves repairing or reconstructing the ligament. The ACL, which joins the femur and tibia, is a crucial soft tissue component of the knee. ACL tears, whether partial or full, are a frequent occurrence among athletes. Complete ACL injuries are often treated with an ACL reconstruction operation by sports medicine doctors and orthopaedic surgeons, in which the torn ligament is replaced with a tissue graft to replicate the original ACL. However, we at Omni treat ACL injuries using an interdisciplinary approach, in which radiologists, orthopaedic surgeons, sports medicine doctors, and physiatrists work together to choose the most appropriate course of action for every patient.
Our doctors and surgeons at Omni continuously research ACL surgery methods to enhance patients’ short- and long-term outcomes because those who have had an ACL injury are more likely to experience osteoarthritis in the knee sooner in life than those who have not.
How to know if one needs ACL Surgery?
The degree of the ACL tear and the patient’s lifestyle will determine if surgery is necessary. An ACL that is totally torn cannot recover on its own. However, research has shown that in some people with a partial ACL tear, the ligament may recover on its own without the need for surgery.
ACL tears (complete and partial):
Two manual tests will be carried out by a doctor to identify whether a tear is partial or complete:
- Lachman test: The doctor will attempt to separate the thigh and shin bones. The bones won’t move at all or move minimally if the ACL is ruptured but still intact.
- The pivot shift test: This test involves having the patient lie on their back while the doctor lifts their leg and rotates their knee. The test results report negative if the bones don’t move.
For patients who only have a partial tear, delaying surgery and waiting to perform it until the ligament has fully healed may be advised.
Complete ACL tears require surgery in order to return to their previous level of activity and prevent further injury. This is especially true for competitive athletes. Nonsurgical therapy may enable certain senior individuals or those whose lifestyles do not involve strenuous exercise to resume their regular routines without an intact ACL.
Anyone with a totally ruptured ACL who resumes unrestricted activity, however, is likely to experience some knee instability. They have a considerably higher chance of tearing their meniscus in. The cartilage meniscus acts as a cushion between the bones that meet at the knee joint. Each knee has two menisci: the lateral meniscus is on the outside of the knee, and the medial meniscus is on the inside. An injured meniscus will result in knee pain and, occasionally, edoema. But more crucially, a torn meniscus raises the likelihood that a patient would eventually develop osteoarthritis of the knee.
When to undergo ACL Surgery?
- Reconstruction surgery for a total ACL tear is typically scheduled for three to six weeks after the accident. This enables the localised inflammation to go away. Patients who have surgery too soon may get arthrofibrosis, a severe scarring reaction.
- Orthopaedic doctors choose when reconstruction surgery should be performed based on the presence of further injuries that must be addressed first, the patient’s level of pain, the patient’s range of motion, and the patient’s level of muscle control when flexing (bending) or extending (straightening) the leg.
- According to some research, delaying ACL reconstruction surgery for six months or longer after injury lowers the likelihood of a clinically significant outcome and raises the likelihood that a patient may require additional revision surgeries in the future.
- In ACL reconstruction surgery, a graft of replacement tissue from one of two sources is used to create a new ACL:
- An allograft made from a patient’s own hamstring, quadriceps, or patellar tendon (tissue from a human organ donor)
- Each patient’s specific circumstances will define the sort of graft that will be used.
- By combining fibre optics, tiny incisions, and tiny devices, minimally invasive arthroscopic procedures are employed to accomplish ACL reconstruction surgery. The tissue graft must be obtained, however, through a little bigger incision. As ACL surgery is an outpatient (ambulatory) operation, it allows patients to leave the hospital the same day as their procedure and return home.
How long does it take to recover from ACL surgery?
Depending on the degree of competition and the type of activity, it typically takes a patient six to nine months to return to sports following an ACL repair.
On the day of surgery, patients are able to walk using crutches and a leg brace. Very quickly following surgery, the patient enrols in a rehabilitation programme to help the knee regain its strength, stability, and range of motion. A series of exercises are used in the rehabilitation process:
- Early on during the healing process, strengthening and range-of-motion activities are begun.
- Exercises for running start at around four months.
- Beginning pivoting exercises occurs about five months.
- Sports competition can resume as soon as six months after the injury.
- Medication can effectively treat the varying levels of pain connected with ACL healing. -Additionally, recovery times differ from patient to patient. The restoration of muscular strength, range of motion, and proprioception of the knee joint are used to gauge when a patient has fully recovered.
- Compared to open surgery, which was the traditional method for performing ACL restoration, arthroscopic surgical procedures have sped up and simplified the recuperation process. But in order to have a satisfactory outcome, it is essential that the patient undergo a period of rehabilitation under the close supervision of a qualified physical therapist and schedule follow-up sessions with the surgeon.
- A ruptured ACL typically cannot be repaired or reattached. The ligament is often completely rebuilt during ACL surgery. The current standard for surgically treating an ACL tear is the ACL reconstruction technique. ACL surgery must be done correctly the first time since picking the wrong surgical approach for an ACL tear might have long-term consequences.
Steps in ACL restoration surgery
There are a few fundamental phases in reconstructing the ACL, but they may vary significantly from different cases:
- Small incisions are made by the orthopaedic surgeon around the knee joint to create access points for the arthroscope and surgical tools.
- To increase the area around the joint, saline solution is delivered using the arthroscope, which is introduced into the knee. The arthroscopic camera, which provides video to a monitor so the surgeon can view within the knee joint, can now be used as well as other surgical tools.
- The surgeon then assesses the meniscus on the left and right side as well as the articular cartilage, which surround the torn ACL. The surgeon treats any lesions in these soft tissues if they exist.
- The graft will then be removed (unless a donor allograft is used). A graft is made by cutting a segment of tendon from another area of the patient’s body, and it is then joined at both ends to bone plugs extracted from the patella and tibia. These plugs assist in stabilising the graft that will grow into the new ACL.
- Using a flexible guide wire, the surgeon inserts the new ACL into the femur and tibia.
- The bone plugs are fastened using screws. These plugs will eventually integrate with the neighbouring bone.
- To finish the process, the surgical tools are taken out.
Can teenagers undergo ACL reconstruction surgery?
Although younger athletes can now undergo ACL restoration surgery thanks to recent medical advancements, younger patients who are still growing need not have the same type of ACL surgery as adults or older adolescents.
On older teenagers, the typical ACL restoration procedure can be carried out successfully. However, it can be challenging to conduct ACL reconstruction on a developing youngster because the standard technique used for adults can harm open growth plates, which can result in unequal limb lengths or abnormalities. As a result, in the past, doctors either delayed ACL surgery until after youngsters finished growing or employed improper anatomical surgical methods.
However, improvements in surgical methods now offer a range of options for treating an ACL tear in younger kids and teenagers.