Surgical Reconstruction of the Anterior Cruciate Ligament: Procedural Details, Preparation, Recovery, and Beyond
ACL reconstruction surgery is a common procedure used to repair a torn anterior cruciate ligament (ACL), one of the four major ligaments in the knee. This surgery helps prevent the tibia from slipping in front of the femur and keeps the knee stable when it moves from side to side [1].
While ACL reconstruction often provides a positive outcome, it is essential for individuals to be aware of the potential risks associated with the surgery. These risks include infection, bleeding, blood clots, knee stiffness or loss of range of motion, nerve and blood vessel injury, continued pain or discomfort, scarring, and failure or improper healing of the graft [1][2][3][5]. Rare but serious complications can also occur, such as fractures of the tibia or femur, vascular injury leading to circulation loss, or the need for revision surgery [1][2][3].
Infection occurs in less than 1% of cases with modern sterile techniques and prophylactic antibiotics, but it can be superficial or deep [2][5]. Blood clots pose significant risks post-surgery and require preventive measures [1][3]. Knee stiffness or reduced motion can result from surgery or prolonged immobilization and may impact recovery [1][3][5]. Nerve damage and blood vessel injury are rare but serious, potentially causing loss of circulation or sensation [1][2][3]. Graft complications such as failure, rejection, or improper healing may necessitate further procedures [1][5].
Anesthetic risks include common side effects like sore throat and headache and rare severe reactions [2][3]. Long-term risks include possible osteoarthritis or recurring knee instability even after successful reconstruction [5]. It is crucial to discuss any preexisting conditions with the surgeon to better prepare for possible complications.
Prior to the surgery, a person will have an intravenous (IV) line put in their arm to receive anesthesia, sedatives, or other medications. A person may need to undergo several weeks of physical therapy before ACL reconstruction to improve surgical outcome. The person will typically get specific instructions from a surgical team regarding when to arrive for surgery, when to stop eating or drinking, or what medications they can safely take [5].
During the surgery, the surgeon will make a small incision in the front of the knee to insert an arthroscope, remove the torn ACL, drill small holes into the tibia and femur, attach the bone anchors, and test the knee's range of motion and tension to ensure the graft is secure [1].
Following ACL reconstruction surgery, a person will almost certainly require physical therapy or other forms of rehabilitation to regain strength, mobility, and stability in their knee. A person will typically be on activity restrictions for a few weeks following the procedure and may require bracing and crutches during recovery for up to a few weeks after surgery [5]. Full recovery and return to sports or other activities can take between 6-12 months.
ACL tears are more common in athletes, particularly those involved in high-impact sports like football. It is important to note that when combined with physical therapy, ACL reconstruction is generally well-tolerated and successful, with most people regaining full function of the knee after the procedure, according to the National Health Service (NHS). Approximately 80% of people do so [5]. A doctor may recommend a person spend time with a brace to help protect the ligaments in the knee before surgery.
References: [1] "ACL Reconstruction Surgery." OrthoInfo, American Academy of Orthopaedic Surgeons, 2021, www.orthoinfo.org/topic.cfm?topic=A00587. [2] "ACL Reconstruction Surgery." Mayo Clinic, Mayo Foundation for Medical Education and Research, 2021, www.mayoclinic.org/tests-procedures/acl-reconstruction-surgery/about/pac-20394675. [3] "ACL Reconstruction Surgery: What to Expect." Johns Hopkins Medicine, The Johns Hopkins University, 2021, www.hopkinsmedicine.org/health/treatment-tests-and-therapies/acl-reconstruction-surgery-what-to-expect. [5] "ACL Reconstruction." NHS, National Health Service (UK), 2021, www.nhs.uk/conditions/acl-reconstruction/.
- Surgical procedures like ACL reconstruction surgeries, which are reconstructive in nature, belong to the realm of science and are often utilized to repair torn ligaments, such as the anterior cruciate ligament (ACL), for maintaining the health and wellness of an individual.
- Pursuing fitness and exercise, including sports like football, can increase the risk of ACL injuries, necessitating ACL reconstruction surgeries and subsequent physical therapy for recovery.
- Mental health plays a crucial role during the ACL reconstruction journey, as individuals who undergo the surgery may experience continued pain, discomfort, or anxiety as part of the recovery process.
- The science behind ACL reconstruction surgery has progressed to minimize risks such as infection, blood clots, and nerve or blood vessel injury, though these complications can still occur, requiring additional attention to mental health and well-being during recovery.
