ACL Repair

Candidates for ACL repair typically include individuals who have suffered an ACL tear and are dealing with knee instability. This is particularly relevant for active individuals who wish to maintain an athletic lifestyle or for those whose occupations involve heavy physical labor. However, surgical intervention is not necessary in all cases of ACL injury. Non-active individuals, especially older adults, may opt for non-surgical treatments like physical therapy or braces. Only certain types of ACL tears can be repaired. An MRI can show that the tear may be able to be repaired, but this may not be able to be fully determined until surgery when the exact location of the tear and quality of the tissue can be evaluated.

Before the procedure, you will be given anesthesia, which could be general (you’ll be unconscious) or regional (only your leg will be numb). Your knee surgeon Dr. Mayo performs ACL repair using an arthroscopic technique, which is minimally invasive and uses small incisions and specialized instruments. A small incision is made and an arthroscope is inserted (a small camera) to visualize the knee joint clearly. At this point, your ACL will be examined to determine if it is torn in a way which can be repaired. If it is able to be repaired, instead of replacing the torn ligament with a graft, as in an ACL reconstruction, the torn ends of the ACL will be sewn back together in a repair procedure. Frequently, a protective brace or tissue augmentation device is used to protect the repair and promote healing.

Recovery timelines after ACL repair can vary based on the individual’s physical condition and the specific demands of their work or sports. Typically, patients can expect to return to desk jobs or light activities within a few weeks after ACL repair surgery. For more physically demanding jobs or sports, the recovery timeline may be longer. Full recovery, enabling a return to high-level sports activities, takes at least six months, but in some cases, it may be up to a year.

Immediately after ACL repair surgery, you will be monitored in a recovery room as the anesthesia wears off until you are able to go home. You will have some discomfort in your knee, especially once the nerve block wears off, but pain medications will be provided to manage discomfort. Your knee will likely be immobilized with a brace, and crutches will be necessary for mobility. Swelling is expected, but can be managed with ice and elevating the knee.

Rehabilitation is an essential part of the recovery process after ACL repair. You will have a personalized rehabilitation program for you, that follows these rough stages.

• Early Stage (Weeks 1-4): The initial goals include reducing swelling, regaining full knee extension, and gradually increasing weight-bearing. The therapist will guide you through gentle range-of-motion exercises and muscle-strengthening activities.
• Middle Stage (Weeks 4-16): As your knee heals, the emphasis will shift towards advanced strengthening exercises, flexibility improvement, and balance training. The physical therapist may introduce low-impact cardiovascular activities such as cycling.
• Late Stage (Weeks 16 and beyond): The final stage is sport-specific or activity-specific training. This includes agility drills, plyometrics, and other high-intensity exercises designed to prepare you for a return to sports or demanding physical work.

Although rare, ACL repair surgery has potential risks, including:

• Infection: This occurs in less than 1% of patients. Antibiotics are administered before surgery to minimize this risk.
• Blood clots: Deep vein thrombosis (DVT) or pulmonary embolism (PE) can occur but are rare (less than 1%). You will be given aspirin to take for 30 days to minimize this risk.
• Repair failure: There is a risk the repaired ligament may not heal properly, leading to recurring instability. This can occur in approximately 10-15% of cases.
• Stiffness or loss of motion: About 5% of patients may experience stiffness or a loss of motion in the knee.
• Nerve or blood vessel damage: This is very rare but can result in numbness or weakness in the leg.

Choosing not to undergo recommended ACL repair surgery can have potential risks, including:

• Increased knee instability: This may lead to frequent episodes of the knee “giving way,” potentially leading to falls and additional injuries.
• Further damage to the knee: Ongoing instability could cause damage to other structures within the knee, like the meniscus or cartilage, leading to early onset arthritis.
• Limited function: You may find yourself unable to return to your usual level of physical activity, including sports or physically demanding work.