ACL Reconstruction Surgery Overview

ACL reconstruction surgery restores knee stability after an injury to the anterior cruciate ligament (ACL) by replacing the torn ligament with a graft from the patient or a donor. It alleviates pain and enhances the ability to return to sports and daily activities. Post-surgery rehabilitation is vital for optimal recovery, strength, and mobility. Improvements in surgical techniques and protocols have enhanced outcomes, enabling individuals to resume active lifestyles.

a 3D illustration of ACL Reconstruction With Arthrex® BTB TightRope® Implant and FastThread™ Interference Screw

Step-by-Step Outline of ACL Reconstruction Surgery

Preoperative Preparation

  • Patient Assessment: Prior to the surgery, the patient undergoes a thorough assessment, including physical examinations and imaging studies (e.g., MRI) to confirm the ACL injury and evaluate the overall condition of the knee.

  • Anesthesia Consultation: The anesthesiologist discusses options with the patient.

  • Instructions: Patients receive preoperative instructions, including fasting guidelines and medication management.

Surgical Positioning

  • The patient is placed under anaesthesia and positioned on the surgical table, often lying flat on their back with the affected leg elevated. The leg is secured to facilitate access to the knee.

Surgical Approach

  • Incision: A small incision is made at the front of the knee, followed by additional smaller incisions (portals) to allow for arthroscopic instruments.

  • Arthroscopy: An arthroscope (a small camera) is inserted through one of the incisions to provide a visual guide of the knee joint and assess any damage to surrounding structures.

Harvesting a Graft

  • Depending on the surgical plan, a graft is harvested to replace the torn ACL. The graft can be sourced from:

    • Autograft: Tissue taken from the patient's own body, commonly from the patellar tendon, hamstring tendon, or quadriceps tendon.

    • Allograft: Tissue obtained from a deceased donor.

Preparing the Knee

  • Removal of Damaged Tissue: The surgeon carefully removes any remnants of the torn ACL and prepares the femoral and tibial sites for graft insertion.

  • Drilling Bone Tunnels: Using specialized instruments, the surgeon drills tunnels into the femur and tibia to accommodate the graft. These tunnels are crucial for securing the graft in place.

Graft Placement

  • Passing the Graft: The harvested graft is threaded through the established bone tunnels, positioned to recreate the natural anatomy of the ACL.

  • Fixation: The graft is secured using fixation devices, which may include screws or interference screws, ensuring that the graft is firmly anchored in both the tibia and femur.

Closure

  • After achieving proper graft placement and fixation, the surgeon assesses the knee's stability and range of motion. The arthroscope is then removed.

  • The incisions are closed with sutures or staples, and a sterile dressing is applied to the surgical site.

Postoperative Care

  • Recovery in the Operating Room: The patient is monitored as they wake up from anaesthesia. Pain management strategies are discussed, and a rehabilitation plan is provided.

  • Follow-Up Appointments: Dr. Mayne schedules follow-up appointments to monitor the healing process, assess the graft integration, and adjust the rehabilitation programme as needed.

Rehabilitation

  • A structured rehabilitation protocol begins shortly after surgery, focusing on regaining range of motion, strength, and stability. The rehabilitation process can take several months, during which the patient gradually returns to their pre-injury activities.

This straightforward outline covers the fundamental steps in ACL reconstruction surgery. Each case may require specific adjustments based on individual circumstances. Each step of the surgery and postoperative care plays a vital role in ensuring a successful outcome, allowing patients to regain function and return to their desired level of activity.