ACL Repair Surgery: When Is It Needed and How Is It Performed?

The ACL, or anterior cruciate ligament, is a vital structure that provides flexibility and stability to the knees. It allows you to use your knees to their full capacity during vigorous activities and high-demand sports, such as football, volleyball, and basketball. 

Despite its strong nature, the ACL is still vulnerable to strains and injuries due to overuse or sudden trauma. Below is an in-depth discussion on why injuries happen and the treatment options available for such conditions.

Source of the Image: Medine plus - Anterior cruciate ligament (ACL) injury

What is an ACL injury?

The anterior cruciate ligament is a tough band of tissue that can be seen inside the knee joint. It holds the cartilages and bones together, specifically the shinbone (tibia) and the thigh bone (femur). By holding these two bones, the cruciate ligaments allow rotational stability and the back-and-forth movement of the knees and legs. 

An ACL injury occurs when the ligament gets overly stretched out, causing it to suffer from a partial or complete tear. Injured ligaments may be classified into four groups based on their severity:

• Grade 1 - slight stretching or tearing of the ligament, causing minimal pain, swelling, and tenderness. 
• Grade 2 - partial tear to the ligament causes the tissue to become loose. There’s moderate pain, bruising, and swelling, which may worsen during movement. 
• Grade 3 - a complete tear in the ligament that causes severe pain and swelling. Patients won’t be able to walk due to intense pain and instability. 

ACL injuries typically happen when you twist your knee while running or landing from a jump. It can also occur when the knees suffer from a direct and forceful blow, like when you get tackled in football.

What are the symptoms of an ACL injury?

The signs and symptoms of an ACL tear may differ based on its severity. Sometimes, slight tears in the ligament do not cause pain, only soreness, and discomfort in the knees. Some of the more common symptoms of this injury include:

• Pain - most patients who suffer a tear in their ACL experience instant pain, which may vary from moderate to severe. The pain may worsen with pressure or movement.
• A “popping” sound or sensation - it is common for patients to feel or hear a loud “pop” as their ACL ruptures.
• Swelling - you will observe swelling in the knee within the first 24 hours of the injury. This occurs as the small blood vessels also rupture, leaking blood and fluid into the knee joint.
• Mobility problem - a Grade 2 and 3 ligament tear may create mobility problems, such as instability or feeling the knee will “give out” when trying to move. Movement may also cause intense pain.
• Limited or loss of range of motion 

How is it diagnosed?

It’s crucial to seek medical assistance immediately if you suffer from an injury or experience the symptoms of an ACL tear. Your orthopedic doctor will perform a physical examination and medical history review. Plus, they will also need to know the events leading to the injury to determine if there are other injuries that need to be considered.

Typically, doctors can diagnose an ACL injury by thoroughly examining the knee structure. But in some cases, physicians may also order some tests to confirm their diagnosis. This include:

• Xray and ultrasound
• MRI
• Diagnostic arthroscopy

These additional tests will help your doctor determine the severity of your injury and rule out other possible injuries, such as a bone fracture. 

How do you treat a torn ACL?

The treatment plan for an anterior cruciate ligament injury will depend on its severity, the age of the patient, and activity level. For mild tears with intact knee stability, doctors may recommend non-surgical treatment options, such as:

• RICE - injuries should be met with first aid treatment while waiting for medical assistance. This includes icing, elevating, and compressing the injured knee.
• Medication - painkillers and anti-inflammatory drugs can help counter the pain and swelling of the injured knee. Your doctor may prescribe acetaminophen, ibuprofen, or steroid injections.
• Knee brace - bracing may help put off the pressure from the injured knee as it heals and recuperates. It can also protect the injured ligament from further damage.
• Physical therapy - a healing ACL injury should undergo rehabilitation exercises to strengthen the muscles and restore normal function. 

But for severe ligament injuries, your orthopedic doctor may recommend surgical repair to reconstruct the partial or complete ACL tear.

How is an ACL surgery performed?

Unlike some muscles, an injured anterior cruciate ligament cannot be stitched back together. Your surgeon will need to rebuild it using a tissue graft obtained either from your own tendon (e.g., patellar, hamstring, or quadriceps tendon), a deceased donor, or a synthetic one.

Generally, doctors perform an ACL repair using a minimally invasive technique called arthroscopy. This type of surgery involves the use of a thin and flexible tube with a tiny camera called an arthroscope and a set of specialized instruments. 

Arthroscopy is more preferred over open knee surgery as it allows patients to recover quickly, produces less scarring, and has little to no complications. Here’s a general play-by-play on how your surgery might go down at your chosen ambulatory facility:

• Your doctor will administer regional or general anesthesia to help you relax and feel no pain or discomfort during the procedure.
• The procedure starts by creating 2 to 3 tiny incisions in the knee, which will serve as the entry point of the surgical instruments.
• Your surgeon will remove the damaged ligament and then drill holes into the bones, which will be used to properly position the tissue graft in place.
• Once placed in the proper location, screws will be inserted to anchor and stabilize the tissue graft. This will then heal and become the new ligament of the knee joint. 
• Your doctor will then stitch up the incision and cover it with bandages.

Most arthroscopic surgery is done on an outpatient basis, which means you can go home the day of the surgery. 

Your doctor may recommend you use a knee brace or crutches to put the pressure off the healing knee joint. Additionally, you will need physical therapy or rehabilitation to gradually restore your normal function.

It will take at least six to twelve months for you to fully recover and get back to doing sports and vigorous activities. 

Raleigh Orthopedic and Panther Creek - Providing high-quality orthopedic care

The Orthopedic Surgery Center of Panther Creek is one of the leading outpatient surgery center in Cary when it comes to patient care and quality services. Our board-certified physicians provide one of the best treatment options using advanced technologies and medical techniques.

Contact us for more information about your surgery or condition.

The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.