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Arthroscopic ACL Knee Surgery - by Vic Goradia, M.D.

ACL video below by Dr. Goradia
who has served as Master Instructor
at knee and shoulder arthroscopy labs
designed to teach various surgeries
to orthopedic surgeons from across
the US and around the world.

The anterior cruciate ligament (ACL) is a major stabilizing knee ligament. It is a tough, non-stretchable rope-like structure that connects the thighbone (femur) to the leg bone (tibia). There are two cruciate ligaments that crisscross in the knee joint. The ACL attaches “anterior” (in front) to the posterior cruciate ligament (PCL). The ACL is more commonly injured than the PCL, and the ACL is the most common knee ligament injury requiring surgery treatment.

How it Gets Injured

People often tear the ACL by changing direction rapidly, slowing down from running or landing from a jump. You might hear a popping noise when your ACL tears. Your knee gives out and soon begins to hurt and swell. When injured, the ACL unravels like a braided rope and does not heal on its own.

Initial Treatment

Initial treatment includes rest, ice, compression and elevation (RICE). Swelling occurs because the torn ACL causes bleeding within the knee. The knee joint will slowly absorb the blood and the swelling will decrease if the knee is rested.

Surgical Evaluation

A thorough evaluation by an orthopaedic surgeon who specializes in knee ligament injuries is needed as soon as possible after injury. As the ACL tears and the knee slides out of place, other structures within the knee are often injured.

Your surgeon will examine your knee and order X-rays. Most injuries can be diagnosed without an MRI. However, if there is any uncertainty, an MRI can be ordered. You will also be encouraged to continue icing your knee and start moving it to help prevent stiffness. In many cases you will be sent to physical therapy before surgery to regain knee motion and strength.

Repairing the ACL With Surgery

Most patients need reconstructive surgery to restore full knee function and resume all activities. Since the ACL unravels like a braided rope, it cannot be simply sewn back together. Instead, the reconstruction involves replacing the ligament with strong, healthy tissue taken from another area near your knee.

A strip of tendon from under your kneecap (patellar tendon), your hamstring tendons, or donor tissue may be used. Your doctor threads the tissue through the inside of your knee joint and secures the ends to your thighbone and leg bone. This procedure is performed with the assistance of a small fiber optic camera called an arthroscope, which permits inspection of the entire knee joint.

In most cases, a brace will not be
prescribed after ACL Surgery. Many
studies show braces prevent the knee
from regaining its own strength & function
by becoming too dependent on the brace.

There are various graft choices and which one will be used depends on a number of factors including your age. Surgery can usually be performed three to four weeks after injury. This allows time for the swelling to decrease and knee motion to return. If surgery is done too early, rehabilitation can actually be hampered.

Why Putting it off is not Always a Good Idea

Less active people may be treated non surgically with a program of muscle strengthening. However, almost every healthy, active patient should have surgery to restore full knee function. Three decades ago, patients over age 40 often were told they were too old to have surgery. But as our knowledge has increased and techniques have improved, we now place no age restrictions on surgery.

Factors such as activity level and lifestyle are much more important than age. It is key to note that if the ACL is not reconstructed, the majority of active patients may experience repeat episodes of their knee “giving-way.” Each time this happens, other structures such as cartilage and menisci can be damaged, leading to early arthritis.

How Long Before I can Return to Sports?

An individualized rehab program tailored to each patient’s progress in essential. Some patients return to sports as early as four months after injury, but typically takes five to seven months for most people.

Is your doctor a member of AOSSM?

Find out if your doctor is a member of American Orthopaedic Society for Sports Medicine. AOSSM members are physicians and allied health professionals who demonstrate scientific leadership, involvement and dedication in the daily practice of sports medicine.