ACL Tear

What is the Anterior Cruciate Ligament (ACL)?

Ligaments are small cords in your body that connect between bones across a joint and provide stability. The ACL is found in the center of your knee and connects the femur (thighbone) to the tibia (shinbone) and helps keep your knee from buckling or slipping out of place. It’s responsible for helping to provide stability within the joint when pivoting or twisting. 

What is an ACL tear?

You may tear your ACL if you land a jump poorly, change your direction too quickly, or stop short. You may hear a pop. After the injury, you may experience knee pain and swelling within 24 hours, followed by loss of motion, a sense of instability and difficulty placing pressure on the affected knee.

How is an ACL tear diagnosed?

Dr. Cleeman diagnoses an ACL tear during an evaluation of your knee. Physical examination usually reveals knee laxity and swelling. To confirm the diagnosis and assess the severity of your ACL tear, diagnostic imaging including X-ray and MRI are obtained. Results of these tests are reviewed with the patient and a personalized treatment plan to return the patient to their prior activity level and function is implemented.

What are the treatment options for an ACL tear?

Because the ACL ligament cannot heal on its own once it has completely torn, the knee becomes unstable. For most people surgery is recommended to return to an active lifestyle and help reduce further damage to other structures in the knee including the meniscus and cartilage. Dr. Cleeman may take a non-surgical approach for the management of ACL tear in sedentary older adults or less active individuals. This may include physical therapy to improve muscle support around the knee and bracing to improve stability. However, athletes hoping to return to their sport will likely need surgery to provide the needed stability and protect the knee from further damage.

What is ACL Reconstruction Surgery?

In most circumstances the ACL cannot be repaired, and Dr. Cleeman will need to replace the torn ligament with new tissue, this is called a reconstruction. There are essentially two options from where to obtain the new ACL tissue. The first is from the patient themselves, called autograft. Autograft options include a portion of the patient’s own hamstring, quadriceps, or patellar tendon. The second option is allograft, in which the tissue comes from another human organ donor. There are pros and cons to each option, Dr. Cleeman together with the patient will select a graft to best meet the needs of each individual. Dr. Cleeman is an experienced orthopedic surgeon who specializes in arthroscopy, a minimally invasive surgical technique. Arthroscopy uses a surgical camera and small incisions that allow Dr. Cleeman to evaluate the structures in your knee and reconstruct the damaged ACL. 

ACL Repair versus ACL Reconstruction

The are rare instances when the ACL may be repaired rather than replaced via reconstruction. If the ACL tears directly off the femur (thighbone) attachment and the remainder of the ACL is maintained intact, Dr Cleeman uses advanced arthroscopic surgical techniques to reattach the ACL to the femur (thighbone) and perform the repair.

What should I do prior to surgery?

Most patients will have pain, swelling, and loss of motion following an ACL tear that needs to be addressed prior to surgery. We commonly recommend a few weeks of physical therapy before you undergo surgery. When you have regained range of motion of the knee and swelling has resolved you are ready for surgery. Studies have shown that delaying surgery for more than 3 months can be associated with increased risk of developing a meniscus tear because of the knee instability.

What will my day of surgery be like?

Once you have checked in you will meet your nurse and the medical team. If necessary, we will shave the hair around the knee. You will receive an IV through which to receive medication including anesthesia and antibiotics. Most patients will have an anesthetic injection to numb their leg and general anesthesia. Surgery typically lasts 1-2 hours depending on the graft chosen and if concurrent injuries to the meniscus and cartilage need to be addressed. After surgery you will spend approximately 1-2 hours in the recovery room prior to going home.

Where will my surgery be performed?

ACL reconstruction is an ambulatory procedure, meaning you will go home the same day. Please remember to arrange for someone to accompany you home. Dr. Cleeman performs ACL reconstruction surgery at an Ambulatory Surgical Center (ASC). There are several benefits to having ACL reconstruction surgery at the ASC.

• Approximately 50% reduced risk of infection compared to surgery in a hospital.
• Time spent by a patient in an outpatient surgery center is close to 25% less than the time spent in a hospital for the same surgery.
• Procedures performed in ASCs take, on average, 30 fewer minutes than those performed in hospitals.
• Outpatient surgery centers can be 45-60% less expensive than hospitals.

How long is the recovery from ACL reconstruction surgery?

Recovery from surgery goes through phases. During the initial first 6 weeks you will wear a brace and use crutches. Depending if concurrent procedures on the meniscus or cartilage were performed at the same time will impact when you can put your weight on the leg. Dr. Cleeman will review this with you after surgery. Pain medication, antibiotics and aspirin are common medications prescribed for post-surgery. Physical therapy and home exercises to regain range of motion to the knee and strength to the surrounding muscles is critical for a successful outcome. Use of a stationary bike without resistance can often be started within the first few weeks, treadmill at 3-4 months and return to sports at approximately 12 months after surgery. These are general guidelines that may be adjusted on an individual basis based on your injury, surgery and recovery.

What are the risks to ACL surgery?

Some numbness or sensitivity around the incisions is common and usually resolves over time. Depending on the study, reports indicate that 5-10% of athletes may re-tear their ACL in the future. Participating in an ACL prevention program after you recover from surgery can reduce this risk. Complications after surgery are rare but may include (but are not limited to) stiffness, infection, and blood clot.

• Physical therapy and maintaining a diligent home exercise program minimizes risk of stiffness.
• Antibiotics given during and after surgery help reduce risk of infection.
• Aspirin taken daily after surgery helps minimize the risk of blood clot. If any problems arise after the procedure, please contact the physician immediately to help resolve the issue.

Will I be able to return to my normal activities after ACL reconstruction?

The goal of ACL surgery is to return you to an active lifestyle including sports. Many patients return to their prior level of activity which may include basketball, soccer, and skiing. However, there are some patients that chose to reduce their activity level post-surgery. We encourage all our patients to remain physically active and if they chose to alter their sports, non-contact activities such as biking, running, and swimming are good alternatives for those people.

For a consultation with an experienced orthopedic surgeon for your ACL tear, contact Manhattan Orthopedics by phone or online today.