About ACL Reconstruction Surgery

ACL reconstruction is a procedure to repair a torn anterior cruciate ligament (ACL), a crucial ligament for knee stability. ACL injuries often occur due to sports activities or accidents and can lead to pain, instability, and restricted movement. In this surgery, the torn ACL is replaced with a graft, which may come from the patient or a donor, helping restore knee function and stability.

Types of ACL Reconstruction Surgery

1. Autograft ACL Surgery

   • Overview: Uses a tendon from the patient’s own body, usually the hamstring or patellar tendon, to replace the ACL.

   • Benefits: Commonly used for athletes due to low rejection risk, as the body recognises the tissue as its own.

2. Allograft ACL Surgery

   • Overview: The torn ACL is replaced with a donor tendon, often from a deceased donor.

   • Benefits: Ideal for those who prefer not to use their tissue. It may offer a quicker recovery as there’s no additional healing from graft harvesting.

3. Synthetic Graft ACL Surgery

   • Overview: Synthetic materials, such as carbon fibre, are used as the graft.

   • Benefits: Used when natural tissue options aren’t viable, though it has a higher risk of complications.

4. Primary Repair ACL Surgery

   • Overview: This involves stitching the torn ends of the ACL back together instead of replacing it.

   • Benefits: Suitable for specific cases, particularly partial tears, and is less invasive. However, it is less common than reconstruction.

Types of Anaesthesia Used for ACL Surgery

1. General Anaesthesia: Puts the patient into a deep sleep, making them unaware during the procedure.

2. Regional Anaesthesia (Spinal or Epidural): Numbs the lower body, keeping the patient awake but comfortable. A sedative may be added for relaxation.

The choice of anesthesia depends on the patient’s health, preference, and surgery requirements.

Techniques for ACL Reconstruction Surgery

1. Extra-articular Reconstruction

   • Overview: Reinforces knee stability by supporting the joint externally without directly replacing the ACL.

   • Benefits: Commonly used in conjunction with intra-articular techniques for severe instability, though less common as a standalone.

2. Intra-articular Procedure

   • Overview: Replace the torn ACL with a graft inside the knee joint.

   • Benefits: Closely mimics natural ACL function, making it preferred for those wishing to return to high activity levels.

Risks of ACL Reconstruction Surgery

While generally safe, ACL reconstruction carries some risks:

• Infection: Low risk, usually prevented with antibiotics.

• Blood Clots: Leg clots are a risk; preventive medication and exercises may be advised.

• Knee Stiffness: Some may experience stiffness, affecting mobility.

• Graft Failure: Rarely, the graft may fail, necessitating another surgery.

• Nerve Damage: Minimal risk of numbness or weakness due to nerve damage.

Procedure for ACL Reconstruction Surgery

1. Preoperative Evaluation: Imaging tests, like MRI, assess the injury and help plan the surgery.

2. Anaesthesia: General anaesthesia is typically used, ensuring no pain or awareness.

3. Graft Harvesting: The surgeon selects a graft from the patient (like the hamstring or patellar tendon) or a donor.

4. Arthroscopic Technique: Small incisions are made, and an arthroscope with a camera allows the surgeon to see and remove the damaged ACL.

5. Graft Placement: The graft is placed in the knee and secured with screws or similar devices.

6. Closure: Incisions are closed with stitches or staples, and a bandage is applied.

Recovery From ACL Reconstruction Surgery

Recovery involves rest, elevation, and gradual weightbearing using crutches. Physical therapy starts soon after surgery to restore strength and flexibility. Pain and swelling should subside over time, and most patients can resume regular activities within 6 to 12 months, depending on adherence to rehab exercises.