ACL Reconstruction Surgery

A good candidate for ACL reconstruction surgery typically includes individuals who have experienced an ACL tear and are experiencing knee instability, particularly those who are active and wish to maintain an athletic lifestyle. The surgery is also suitable for individuals who have occupations that require heavy or manual labor, or those whose daily activities involve significant knee use.

However, not every ACL tear requires surgical intervention. Non-active individuals, especially older adults, might opt for non-surgical treatments such as physical therapy or braces. In some instances, the ligament can be torn in a way that can still provide some stability to the knee so that certain activities can be performed without issues.

Your knee surgeon Dr. Ben Mayo performs ACL reconstruction surgery with you completely asleep under general anesthesia. Oftentimes, a regional nerve block is also performed, which will make parts of your leg numb and weak for a day or two after surgery to help with pain control.

The procedure itself is performed using an arthroscopic technique, a minimally invasive approach using small incisions and specialized instruments. Depending on which graft is used to rebuild the ACL, you will have 2-3 small poke holes around the knee, and 1-2 other incisions that are about 2-3 inches in length.

In most cases, Dr. Mayo prefers to take the graft from another part of your knee (autograft). This is either a part of the patella tendon, quadriceps tendon, or hamstrings tendons. The graft is then prepared using sutures that will help hold it in place in your knee while it heals.

Two small incisions are then made in the knee and a small camera and instruments are used to see the inside of the knee joint and assess what damage has been done. If you have any cartilage or meniscus damage, they would be addressed at this point. The pieces of the torn ACL are then removed.

The graft is then placed into the knee. Small holes, or sockets, are drilled into your thigh and shin bones, and the graft is threaded through these holes. The graft is secured in place with screws or other fixation devices to hold it in position. Over time, the bone tunnels will heal around the graft.

Like all surgical procedures, ACL reconstruction comes with certain risks, though they are relatively rare:

• Infection: Occurs in less than 1% of patients. Antibiotics are given before and after 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 on an aspirin after surgery to minimize this risk.
• Graft failure: The new ligament may not heal properly, or may be reinjured, leading to recurrent instability. This occurs in approximately 5-10% of cases, but is minimized with following therapy protocols and not returning to sport too early.
• Injury
• Stiffness or loss of motion: Approximately 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.

If your orthopedic sports surgeon recommends ACL reconstruction and you choose not to undergo surgery, there are potential risks:

• Increased knee instability: This can result in frequent episodes of the knee “giving out,” potentially leading to falls and injuries.
• Further damage to the knee: Continued instability may lead to damage to other structures in the knee, like the meniscus, cartilage, or ligaments on the outside of hte knee, leading to early arthritis.
• Limited function: You may be unable to return to your usual level of physical activity, including sports or demanding work.