ACL Surgery Explained: Everything You Need to Know for a Faster Recovery

An Anterior Cruciate Ligament (ACL) injury is a very popular knee injury, mostly common amongst athletes and other people physically active individuals. Torn ACL leaves your knee not only unstable but also painful resulting in inability of doing even simple household tasks or sports-related activities. Luckily, these days, with the use of modern ACL surgery, patients are able to regain their mobility quite successfully and can once again lead an active mode of life.

This thorough guide will cover all aspects of ACL surgery such as who is eligible for it, the surgical method, the time-frame of healing, the process of rehabilitation, the success factor, and the most frequently asked questions.

What Is ACL Surgery?

ACL surgery is a minimally invasive orthopedic procedure used to repair or reconstruct a torn anterior cruciate ligament (ACL) in the knee. The surgeon performs the procedure using an arthroscope, a small camera inserted through tiny incisions. Specialized surgical instruments are also inserted through these small openings. This approach helps reduce pain, minimizes scarring, and supports a faster recovery compared to traditional open surgery.

This type of approach results in:

• Much smaller incision marks
• Less post-operative pain
• Smaller amount of blood loss
• Fast recovery
• Fewer complications like infections

What Is the ACL?

One of the four principal ligaments that support the stability of the knee joint is ACL, that connects femur to tibia and controls the movement of the femur in forward direction as well as prevents excessive rotation of the knee which is a rotational component.

A healthy ACL enables one to do:

• Walk confidently
• Run
• Jump
• Pivot
• Switch direction rapidly
• Playing sports without getting injured

Common Causes of ACL Injury

Sudden rotational movements mostly are the cause of ACL injury. It is not necessarily caused by a collision or direct contact to the knee.

Some common causes are:

• Injures from sports
• Football
• Cricket
• Basketball
• Badminton
• Volleyball
• Skiing
• A sudden stop
• Wrong landing after jumping
• Road accidents
• Getting hurt by not landing or falling the right way

Symptoms of an ACL Tear

Some symptoms are:

• Patients often hear a popping or snapping sound when they sustain the injury.
• Severe knee pain
• Very rapid swelling
• Knee feels unstable
• Trouble in walking
• Decreased range of motion
• Feeling as if your knee will give way

If these signs last a prolonged time without improving, see a doctor who specializes in knee conditions especially that the person is a doctor in an orthopedics.

Who Needs ACL Surgery?

There are people who get ACL hurt and still don’t have to receive surgery.

Commonly, ACL reconstruction is suggested only for:

Sports players

Sports people, due to the nature of their activities, usually go for knee surgery in order to protect knees for future competitions.

Young Adults

Active young folks who do not want limitations in activity due to injury will generally have successful knee repair through surgical means.

Torn ACL

In most instances, the ligament has to be replaced as the tear is complete and a ligament naturally cannot regenerate on its own.

Reciprocated Instability

If the person has recurrent episodes of his knee buckling while walking or doing normal activities then getting surgery is typically the most effective remedy to his problem.

Ligament Involvement of More Than One

ACL replacement will sometimes be needed if other damaged structures in the knee were also affected in the injury such as other ligaments or the meniscus.

Tests Required Before ACL Operation

The physician may order some of the following:

• Patient evaluation focusing on the knee joint
• MRI (magnetic resonance imaging)
• X-rays or other plain imaging tests
• Special maneuvers or tests done on patient to confirm or rule knee instability
• Testing on patient to see if there is any problem in function

Pictures taken by MRI machine are still the best way of showing tears of the ACL.

How ACL Surgery is Done

Tears of an ACL are now operated most of the time via arthroscopic method by an expert surgeon.

Step 1: Giving Anesthesia

Either general or spinal anesthesia is going to be given.

Step 2: Arthroscopy

Pretty small cuts around the knee are made through which a special camera is passed. These small holes are what make knee arthroscopy a minimally invasive or less invasive surgical technique.

Step 3: Damaged Tissue Removal

After thorough visual inspection of knee joint, a small amount of healthy surrounding tissues that might have been injured along with the ACL is also removed or repaired. Once done, the major portion of the destroyed ligaments is cut out or pulled out and sent to the pathology lab if needed.

Step 4: Graft Prepping

The surgeon makes the choice of one of the tendons or ligaments from your body or a donor tendon (allograft) which will be used as a replacement to your torn ACL.

Popular options include:

• Hamilstrings
• The ligament attached to the bone below the knee (patellar tendon)
• The muscle on the front of the thigh and its attachment to the knee joint
• Different graft choices from donor tendon tissue

Step 5: Cutting the tunnels

The doctor or the orthopedic surgeon is making holes on the bones which the graft is supposed to go through and anchor in the body.

Step 6: Graft Insertion

The graft is placed properly into the tunnels and secured with suitable fixation materials (hardware or device).

Step 7: Fixating

The new ligament is stabilized by fixation devices or screws.

The process usually lasts for about 60, 90 minutes.

Types of ACL Grafts

Hamstring Tendon Graft

The most popular one.

It has the following advantages:

• Less discomfort after surgery.
• Minimal invasion since the skin opening is tiny
• Long term results are generally very encouraging.

Patellar Tendon Graft

Better used for athletes.

Pros:

• Good stability provided
• Solid joint stabilization

Quadriceps Tendon Graft

Good strength. Safe. It is being increasingly used for these reasons.

Allograft

Allograft tissue means tissue that comes from another human who has donated the tissue.

This is the most common recommendation in the following circumstances:

• Seniors who have reached their senior years
• Reconstruction of a previously reconstructed ACL (Revision ACL Surgery)
• Individuals with a modest level of physical activity

ACL Surgery Benefits

An ACL reconstruction that goes well usually leads to the following:

• Knee feel very much like the original
• Less pain
• Joint movements feel smooth and natural
• Ability to go back playing a sport
• No meniscal tearing will be prevented
• A more stable gait on the floor
• A much better way of living

Recovery after ACL surgery

Rehab and patient effort largely define the recovery process.

The first week

• Pain relief is the aim.
• Ice helps in reducing the pain and swelling.
• Sedentary activity should be encouraged.
• Walking without support is not advisable yet.

Weeks 2, 6

• Get the knee back to normal range of motion.
• Build up strength in the muscles around the knee joint.
• Gradually start weight-bearing as able.

Months 2, 4

• Working on your balance.
• Cycling with a stationary bicycle is an option.
• Training to help you do things around the house, etc.

Months 4, 6

• Recovery focused on your preferred sport.

Months 6, 9

There will be very few exceptions in which an individual who has received the complete rehabilitation will not be able to safely resume all forms of activity and sports in this range of months.

The role of physiotherapy

Physiotherapy is as vital as the surgery itself.

Physiotherapy brings with it:

• Regaining muscle strength
• Making the body parts more flexible
• Knee movement is not affected by stiffness
• Eliminating swelling
• Body balance
• The recurrence of injury can be stopped

Surgical techniques aside, adherence to one’s rehabilitation plan is key in determining the patient’s long-range results from the surgery.

Surgery Success Rate

Approximately 730 patients had an arthroscopic ACL reconstruction, and around 80% of them have good results. Of course, the success of surgery depends a lot on the capability of the surgeon and how thoroughly and efficiently the rehabilitation period is carried out.

Things you may not know that influence the chances of a successful surgery include:

• Surgical skill of the doctor (surgeon’s experience) –
• Type of material (graft)
• Age of the client (patient) –
• Gait and movement of the patient
• Fitness level the higher the level, the better
• The time after which one decides to return to one’s sport

Risks of ACL surgery

Though very few people end up with complications from this kind of surgery, it is still an operation like any other in the medicine world and complications can happen in rare cases. Some of them are:

• Infection
• Blood clots
• Stiff knee
• A doctor with an orthopedic specialty who has completed fellowship
• Doctor who has handled the treatment for patients with sports injuries
• Doctor who has an extensive background in ACL repair with arthroscopy
• High success rates surgical performance
• Well-equipped surgical centers.

Can You Walk After ACL Surgery?

Definitely.

A day or so following the surgical procedure, many patients are already on foot with crutches. When to take the full weight is a matter of a surgeon’s recommendation and the nature of associated injuries.

Can ACL Heal Without Surgery?

Some partial ACL injuries may heal through rehabilitation in certain cases.

Naturally, full ACL tears almost never happen to mend without medical intervention and quite often need a reconstruction in order to stabilize knee joint again.

How Long Does Recovery Take?

Recovery timeline with major achievements:

• Being able to walk without discomfort: 2, 4 weeks
• Back to work: 2, 3 weeks
• Driving: 4, 6 weeks (depending on injured leg and doctor’s advice)
• Resuming running: 3, 5 months
• Play sports again: 6, 9 months

How Can You Speed Up Recovery?

To get along well, one has to:

• Physiotherapy sessions with the specialist
• Eat lots of protein to gain strength
• Icing to reduce inflammation
• Do regular exercises as prescribed
• Stay away from smoking
• Regular check-up appointments
• Do not get into sports before medical permission

Why Early Treatment Is Important

To put it simply, leaving a significant ACL tear for extended time is a recipe for more problems. It can lead to, for example:

• Tears and other injuries of the meniscus
• Damages to the articular cartilage
• Development of chronic knee instability
• Knee joint changes characteristic of early osteoarthritis
• Decreased sports activity level or athletic performance

Getting a prompt diagnosis from a qualified and experienced orthopedic surgeon, if the knee joint injury is not clear from physical examination or imaging only, is very important to optimize knee health for the years to come.

The Bottom Line

Through ACL surgery, the medical approach of ligament injuries has been revolutionized, making it now possible for the affected individuals to enjoy an active and a pain-free lifestyle. With the development of arthroscopic methods, the improvement in the availability of quality graft material and the establishment of the post-operative rehabilitation programs, ACL reconstruction has become one of the highly successful orthopedic surgeries.

The best results are achieved with a prompt diagnosis, expert surgical management, and committed rehabilitation. As soon as you feel a knee joint that is still giving you persistent stability issues after an ACL injury, make sure to consult a qualified orthopedic surgeon. You can be back at the gym, in the football field or in sports in a way that is safe for you with the help of the right treatment, rehabilitation and physical therapy guidance by your doctor or therapist.

FAQs

1. Do you need surgery to treat ACL tear?

As a matter of fact, it is usually possible to avoid ACL surgery altogether by undergoing non-surgical treatments such as rest, physical therapy and the use of a brace for knee support. However, surgical reconstruction is considered a necessary step for those who want to continue with their usual and intense level of activity and physical recreation. The surgery has been known to bring about pain reduction, better joint function and the avoidance of chronic knee problems especially when combined with rehabilitation.

2. How much pain does an ACL injury cause?

The pain caused by tearing of the ACL can be extremely severe. The person may be unable to straighten, bend or put a foot on. However, the actual severity of a torn ACL injury will largely depend on the other structures of the knee which also may be affected. The amount of pain that people experience varies widely, and that is why it is very important to see a doctor right away for an accurate diagnosis. In general, most people with an ACL tear do need crutches or a walking frame for their first couple of weeks in the aftermath of an injury and before they start rehabilitation with a physiotherapist.

3. Why do people get ACL injuries?

It is estimated that an athlete is at risk of tearing his ACL every 6 months depending on the sport and how often the knee needs to pivot, cut or twist. An ACL injury is very common to sports such as football (American football), soccer, basketball, and downhill skiing. There are certain activities, such as landing from a jump, cutting and twisting, that make one much more likely to tear the ACL. A torn ACL is also a frequent result of a motor vehicle crash especially if the knee is being forced back.

4. What are the symptoms of an ACL injury?

If you have an ACL injury, you might have a range of symptoms and signs. These include knee pain that gets worse with time, a swollen, or effused knee, decreased range of motion, and feeling like your knee is going to give out.

5. Why is an MRI needed to diagnose an ACL injury?

A torn, ruptured or stretched ACL can be diagnosed with X-rays only to a certain degree because an X-ray does not give images of soft structures. The best way to find out exactly what your doctor needs to know is to undergo an MRI scan that is the most suitable imaging method for the soft tissue structures that make up the ACL.

6. How is an ACL injury treated?

Depending upon an individual’s level of physical activity, an ACL injury can sometimes be treated successfully without surgery. Rest and the use of protective devices, like ortho braces, and doing physiotherapy exercises are all common forms of nonsurgical treatment. But, on the other hand, many active individuals and especially athletes with the ACL deficiency will be advised to undergo surgical intervention to repair the injury.

7. Who is a good candidate for ACL surgery?

Prior to deciding on ACL surgery for you, one of the important things that we need to find out is a few medical details. We will take your overall health into consideration, assess the other injuries your knee might have sustained at the same time with the ACL tear, how badly the knee joint is worn out if at all, and also the type of the sports you are playing or the level of athletic and physical activities that you are doing and what your career aspirations are in the first place. In other words, the decision to go for ACL surgery is based on the evaluation of each one of these factors and that is why only a doctor can determine if you are suitable to undergo the surgery or not.

8. What’s the difference between an ACL injury and a torn meniscus injury?

To understand the difference you just need to know that ACL is one of the four major ligaments of the knee while meniscus are pieces of fibrocartilage acting as shock absorbers in the knee. Also, the ACL functions in stabilizing the knee as a deep ligament, whereas the menisci act as the cushion between two bone surfaces and hence they bear a great deal of weight as well. One of the common symptoms of ACL injury is the knee giving in or instability whereas meniscus injury is associated with a feeling of catching the movement or the locking of the joint. You can refer to the above information that lists common characteristics of an ACL and meniscus injury. However, in real-life situations, the injuries to these soft tissues rarely occur independently and they usually are complicated and overlapping, both in clinical presentations and treatment approaches. If your knee is still giving your you the same symptoms even after you have taken all the necessary rehabilitation, a medical consultation by an expert will become necessary to find out the real problem, be it ligamentous tear, meniscal tear or even a combination.