Anatomic ACL Reconstruction

Overview

Prior to surgery, it may be beneficial to start with some prehabilitation to strengthen the muscles around the knee and restore the range of motion. Outcomes are generally better once the swelling of the knee has decreased and motion restored. If surgery is performed before motion of the knee has returned, it may be difficult to get the motion back after surgery. However, there may be other conditions which may affect timing of surgery. 

Usually the ACL is reconstructed (make a new ACL) and not repaired. To make a new ACL, a tendon graft is used. The tendon can be taken from the patient (autograft) or taken from a tissue donor (allograft). The choice of tissue for the graft depends on many factors such as patient age and activity level. In the younger, active patient, autograft tissue is recommended as there is decreased failure rate with autograft tissue. For autograft tissue, Dr. Shelton will generally use the patellar tendon which has the longest track record. For other patients, Dr. Shelton may recommend a quadriceps tendon or hamstring tendon. 

Regardless of the tissue selection, the idea is to place the graft in the anatomic location of the native ACL. The surgery is usually done using minimally invasive techniques using arthroscopy. The previous ACL stump is removed at the time of surgery and a bone tunnel is created at the anatomic footprint of the ACL origin and another at the anatomic footprint of the ACL insertion. The graft is then placed in these tunnels and secured in place. Other conditions like meniscus tears can be treated at the same time as the ACL reconstruction. Complete recovery from ACL reconstruction is usually around 8-9 months. 

Potential Implications

Blood loss, infection, damage to nerves or blood vessels, graft failure, deep vein thrombosis (DVT), and need for additional surgery.