ACL Reconstruction

About ACL Reconstruction

Anterior cruciate ligament reconstruction replaces a torn ACL, a key stabilizing ligament inside the knee that prevents the shin bone from sliding forward and controls rotation. ACL tears commonly occur in sports involving pivoting, cutting and jumping, and are more frequent in female athletes. Because the torn ligament does not heal well on its own, reconstruction with a tendon graft is the usual surgical treatment for people who wish to return to pivoting activities or who have recurrent instability. Common autograft options are the central third of the patellar tendon with bone blocks at each end, the hamstring tendons and the quadriceps tendon. Patellar tendon grafts are associated with more pain at the front of the knee, while hamstring grafts cause less donor site pain. Allografts from deceased donors avoid harvesting tissue but have been associated with higher failure rates in young active patients. The operation is performed arthroscopically: the remnant of the torn ligament is cleared, tunnels are drilled in the femur and tibia at the anatomical attachment sites, and the graft is passed through and fixed with screws or suspensory devices. Some surgeons add a lateral extra articular procedure to improve rotational control in high risk patients. Structured rehabilitation focuses on restoring motion, strength and neuromuscular control, and return to sport is a gradual process measured in months. Complications include graft failure, stiffness, infection and a nodule of scar tissue called a cyclops lesion. In the long term, ACL injury is associated with an increased risk of knee osteoarthritis.