Overview
The anterior cruciate ligament (ACL) is the major stabilizing ligament of the knee. The ACL is located in the center of the knee joint and runs from the femur (thigh bone) to the tibia (shin bone), through the center of the knee. In this position, it functions to prevent a buckling type of instability of the knee.
ACL reconstruction is surgery to replace the ligament in the center of your knee with a new ligament. The anterior cruciate ligament (ACL) keeps your shin bone (tibia) in place. A tear of this ligament can cause your knee to give way during physical activity.
The two groups
Reconstruction of the ACL is the surgical treatment of choice once direct primary repair of the ligament has been shown to result in persistent laxity and instability of the knee. The aim of reconstruction is to restore stability of the knee without restricting its other functions, especially motion.
Reconstruction techniques can be broadly split into two groups:
- Extraarticular reconstruction
- Intraarticular reconstruction
Extraarticular reconstruction
Extraarticular reconstruction uses the structures on the lateral side of the knee to mimic the actions of the ACL. For example, by surgically tightening the iliotibial tract, excessive lateral excursion of the tibia is prevented.
Intraarticular reconstruction
Intraarticular reconstruction tries to reproduce the anatomic ACL. The donor tendon graft spans the intercondylar notch from the origin to insertion of the ACL.
Autograft
Autograft is the most widely performed orthopedic ACL reconstruction. The technique involves moving the patient’s own tissue. Surgeon preference is the primary factor in selection of the tissue.
Allograft
An allograft is tissue that is harvested from a cadaver.
Advantages are obvious:
- No donor site morbidity
- Less operative time.
Synthetic
The advantages of synthetic grafts are the lack of harvest site morbidity, off the shelf availability, and no disease transmission. However, the failure rates of synthetic grafts were unacceptable. Synthetic grafts currently have inherent mechanical properties that do not closely resemble the normal ligament and as they are not living, they cannot repair themselves, as can natural ligaments.
Recovery
During the first 3 or 4 days, efforts are directed at minimizing the swelling and reestablishing quadriceps function.
During recovery time, cryotherapy and elevation of the knee, leg and ankle are emphasized. Frequent movement increases blood flow return from the extremity (e.g. ankle pumps).
Crutches are used to walk bearing weight as per doctor's orders. The emphasis is on a normal gait without limping.
Wear comfortable shoes.
Stay within your safe range of motion as directed by your doctor.
Bathe and shower after surgery as your doctor directs.
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