Anterior Cruciate Ligament – ACL Reconstructive Surgery
An ACL tear is most often a sports-related injury, but can also occur during rough play, mover vehicle collisions, falls, and work-related injuries. Most often ACL tears occur when pivoting or landing from a jump. In fact, about 80% of sports-related ACL tears are “non-contact” injuries, without the contact of another athlete.
The diagnosis of an ACL tear is made on history and examination with 95% accuracy. Patients who have an ACL tear often feel that the knee came apart and came back together. They may have felt a “pop” in their knee during the initial injury, or that the knee gives-out from under them. Swelling is usually but not always immediate, and it is often a “big deal” and the athlete cannot continue to play. ACL tears cause instability and swelling, but often are not painful unless the swelling is severe. On examination, there are three tests that suggest a torn ligament, and in the right hands are very accurate. Sometimes the patient “guards” and a knee with a torn ACL does not feel loose. An MRI scan is an excellent way to check these knees, confirm a torn ACL, and check for concomitant injuries like a meniscus tear or typical bone bruises.
Surgery for ACL injuries involves reconstructing ligaments. Repairs do not work except in the very young as the ACL tissue deforms before it tears. Partial ACL tears are insufficient and usually need to be reconstructed as well. ACL reconstruction surgery uses a graft to replace the ligament. The most common grafts are autografts (using part of the patient’s own body, most commonly the patellar tendon, quadriceps tendon or hamstring tendons) or allografts (from a donor). There are many advantages and disadvantages to both types of grafts, and Dr. Noy will discuss these with you to help you choose the best graft choice for you.
Dr. Noy does ACL surgery exclusively through arthroscopic techniques, utilizing very small incisions and specialized cameras and equipment. The surgery is done as same day surgery, using a regional block which helps decrease anesthetic risks, decrease pain, and allows quicker initiation of exercises. Because of special surgical and post-surgical techniques, most patients do not need to use narcotics after surgery, achieve at least 90 degrees of flexion the same day and can get back to a desk job within one week without crutches. A brace is used to protect the leg for 2-6 weeks, and a custom playing brace is obtained for some athletes to use during the first year. A good physical therapist is very important in optimizing your full recovery and Dr. Noy will help you obtain one if necessary. Therapy is usually started after the first post-surgical visit, but exercises are started immediately at home. Once you obtain full range of motion and strength after surgery (which is checked on a computerized test), you often will be allowed to get back to sports with a brace. This has been as early as 2 months, but most patients are in the 3-4 months category.
Many orthopedic surgeons use arthroscopic surgery rather than open surgery for ACL injuries because: