Information Regarding ACL Reconstruction
- You are scheduled for an ACL Reconstruction.
The ACL or Anterior Cruciate Ligament is one of the major ligaments in your knee. Injury to this ligament can cause instability and recurrent giving way episodes, which could injure other important structures in your knee. Often the original injury of an ACL coincides with injury to the meniscus cartilage. Surgical treatment of an ACL tear involves reconstructing the ligament to restore stability of the knee. The tissue used to replace the ACL is usually borrowed from another part of your knee, (or donated tissue could be used.) The most commonly used tissue is a portion of your hamstring tendons. The operation is carried out with the aid of an arthroscope, which allows your surgeon to see the entire knee through very small incisions. A slightly longer incision will be made to obtain the tissue or graft that is used to reconstruct the ligament. Tunnels are made in the bones on either side of the knee joint and the tissue grafts are anchored on each bone. The anchoring devices utilized are left in on a permanent basis.
The goal is for the graft to heal to the bone and at one year, will be as strong as your original ACL. To decrease the amount of pain you have after surgery, a femoral nerve block will be offered to you. Immediately after surgery your leg will be weak as a result of this nerve block. You are to use crutches for 24 hours, and then use them as needed. Depending on other injuries that may have occurred at the time of your original ACL tear, your surgeon may ask you to use crutches longer.
After surgery your knee will be swollen and you will have some pain that will be controlled by medications prescribed by your doctor. Ice, anti-inflammatory medications and rest will all decrease your pain. Most patients are able to walk comfortably without crutches in four weeks. In 8 to 12 months you may return to cutting type sports. Rehabilitation is an important part of your recovery and your surgeon will have you participate in a physical therapy program
- Commonly asked questions about ACL reconstruction.
- How long does the surgery take? How long will I be there?
This is an outpatient procedure. While the operation only takes one to one and a half hours, between checking in and the anesthesia and the recovery time, plan on spending three to four hours at the Surgery Center.
- How long will I be off work?
This depends on the demands of your job. If your job is one in which you sit most of the day, you may return to work in a week. However if you are on your feet, placing demands on your knee, you will likely be out of work for four to six weeks.
- What if I have a meniscus cartilage tear or other injuries in addition to the torn ACL?
Other injuries will be addressed at the same time as the ACL reconstruction. If the meniscus is torn at the rim, it will be repaired. Unfortunately, most menisci are torn in areas that will not heal. The torn portion is then removed, leaving as much of your normal meniscus as possible. Your rehabilitation program may change depending on associated injuries
- Do I have to go to sleep for the operation?
You will have a choice of anesthesia. Most people are comfortable having a general anesthesia in which you would be sleeping during the operation. Another option is a spinal, in which you may sleep with the sedative medications given. We recommend you have a femoral nerve block which will decrease your pain in the period immediately after surgery and often for 10 to12 hours.
- When will I be able to get back to playing soccer, basketball, tennis, gymnastics or skiing or other contact sports?
Your doctor will ask you to avoid any activity that puts your knee at risk of reinjury for 8 to 12 months. This is dependent on your rehabilitation and your ability to rebuild your quad. and hamstring muscles.
- Will I be able to get back to my normal activity?
This is the goal of surgery. The success rate is 90 to 95%.
- How long does the surgery take? How long will I be there?
- The process before surgery.
- Decide to have the operation.
- Discuss all questions and concerns with your surgeon.
- Our authorization secretary will contact your insurance and let you know what portion of the bill your insurance will cover.
- Once you have been authorized, pick a date… your surgeon will ask you to have the full motion of your knee prior to surgery, often you will have physical therapy prior to the operation.
- Arrange for family and friends to assist you on the day of the operation and after you get home. You cannot drive yourself home.
- Schedule your therapy and post-op (after the operation) visit with your surgeons P.A (physician assistant)
- If you smoke, quit.
- If you take birth control pills, we recommend you be off these for 2 weeks before surgery and 4 weeks after surgery.
- Risks of procedure.
Your surgeon takes into consideration the risks and possible complications and weighs the benefits, goals and anticipated outcome prior to offering you an operation. There is a less than 1% risk of infection. There is a less than 1% risk of major nerve injury, however often patients develop a numb patch on their leg around the incision. The numb areas often shrink in size over a six month period, but some persist permanently. There is a 3% chance of developing a DVT (deep venous thrombosis- a blood clot in a vein) Your surgeon will ask you questions before the operation to help understand and decrease this risk. You will also be given instructions to help avoid it after surgery. There is a rare (less than 1 in 200,000) chance of loss of life or limb.
- Frequently asked questions after surgery
- Is my knee supposed to be swollen? How long before the motion returns to normal? Your knee will be swollen after the operation. Ice, elevation, anti-inflammatory medications, will help decrease the swelling. It will continue to swell when you increase your activity for up to 6 weeks and by the 3 month mark the swelling should be minimal. You should be able to completely bend and straighten your knee by 4 to 6 weeks after the operation.
- What should I do if I run out of pain medications? Should it hurt?
The first week your knee will hurt, sometimes in the back of the knee and down the shin. You will have a variety of pain management options. A prescription for narcotics will be given to you after the operation. If you run out, call the office during business hours. It is our policy that narcotic pain medications will not be refilled or phoned in after hours or on the weekends. Inventory you medication on Friday to ensure you have enough to carry you through the weekend. Narcotics are not refilled over the weekend.
- What is the routine follow up?
- 7-14 days with the PA for a wound check.
- This is when paperwork for missed work, disability, school and PE notes will be completed.
- 6 weeks with your Surgeon
- 3 months with the PA for assessment of progress
- 6 months with your Surgeon for exam and possible release to increased activity
- When can I drive?
Depends on which knee was operated, and when you are off the narcotic pain medication. Left knee within 1 week, right knee 2-4 weeks. Do not drive if you do not feel confident you can jam on the brakes to prevent hitting someone! Do not drive if you have enough pain to use narcotic pain medication.There will be a handout given you after the surgery with more specific information regarding elevated temperature, medication schedules, and wound and dressing care.