Cruciate Ligament (ACL) Surgery

Anterior cruciate ligament (ACL) surgery is a surgical procedure performed to repair or reconstruct torn or damaged ligaments in the knee joint. The cruciate ligaments are essential structures that provide stability to the knee, and when torn, they can cause pain, instability, and limited range of motion.

In this comprehensive guide, you will find everything you need to know about ACL surgery. We will cover what the surgery involves, who is a suitable candidate, how it is performed, the recovery process, as well as its risks and possible complications.

The knee joint consists of three bones: the femur (thigh bone), the tibia (shin bone), and the patella (kneecap). Four main ligaments hold these bones together and provide stability to the knee joint:

• Anterior Cruciate Ligament (ACL): Prevents the tibia from sliding forward in front of the femur and controls rotational movements of the knee.

• Posterior Cruciate Ligament (PCL): Prevents the tibia from sliding backward behind the femur.

• Medial Collateral Ligament (MCL): Located on the inner side of the knee, it prevents the knee from bending inward.

• Lateral Collateral Ligament (LCL): Located on the outer side of the knee, it prevents the knee from bending outward.

The cruciate ligaments are vital for maintaining the stability and function of the knee joint. When these ligaments are torn or damaged, they can lead to instability, pain, and limited movement in the knee.

A cruciate ligament tear usually occurs as a result of a sudden and severe force impacting the knee. This force may arise during twisting, bending, or sideways movement of the knee. Common situations that can cause a cruciate ligament tear include:

• Sports injuries: Sudden stops, changes in direction, or falls during sports such as football, basketball, or skiing can lead to cruciate ligament tears.

• Traffic accidents: Receiving a strong blow to the knee during a traffic accident can result in a ligament tear.

• Falls: Falling from a height or down stairs can cause cruciate ligament injuries in the knee.

A cruciate ligament tear usually causes sudden and severe pain. Other symptoms may include:

• "Popping" sound: A popping sound may be heard in the knee at the moment of the tear.

• Swelling: Rapid swelling can occur in the knee.

• Limited range of motion: Difficulty in moving the knee may be experienced.

• Instability: A feeling of looseness or giving way in the knee.

• Pain: Pain in the knee that worsens with movement or touch.

The diagnosis of a cruciate ligament tear is made through physical examination and imaging tests. The doctor will examine your knee to check the stability of the ligaments. Additionally, imaging tests such as magnetic resonance imaging (MRI) may be requested to visualize the internal structures of the knee in more detail.

Cruciate ligament surgery is a surgical procedure performed to repair or reconstruct torn or damaged cruciate ligaments. The surgery is usually done arthroscopically, meaning it is performed through small incisions in the knee.

Types of Surgery:

• Anterior Cruciate Ligament (ACL) Surgery: In cases of ACL tear, the torn ligament is typically replaced with a tendon graft taken from another part of the body. This graft is usually harvested from the hamstring tendons or the patellar tendon.

• Posterior Cruciate Ligament (PCL) Surgery: In cases of PCL tear, the torn ligament can sometimes be repaired. However, in most cases, the PCL is also replaced with a tendon graft.

• Anesthesia: The surgery is usually performed under general anesthesia or spinal anesthesia.
• Arthroscopy: Small incisions are made in the knee, and through these incisions, an arthroscope (a small camera) and surgical instruments are inserted.
• Ligament Repair or Reconstruction: The torn ligament is repaired or replaced with a tendon graft. The graft is placed into bone tunnels and fixed with screws.
• Closure: The incisions are closed with stitches.

Before the surgery, it is important to have a detailed consultation with your doctor. During this meeting, you should share your expectations, medical history, and medications you are using. Your doctor will assess whether the surgery is suitable for you and provide pre- and post-operative instructions.

Things to do before surgery:

• Quit smoking and alcohol: Smoking and alcohol can delay wound healing and increase the risk of complications.

• Stop using blood-thinning medications: Drugs like aspirin and ibuprofen increase bleeding risk. You may need to stop these medications before surgery according to your doctor’s instructions.

• Stop herbal supplements: Some herbal supplements can increase bleeding risk or interact with anesthesia.

• Do not eat or drink after midnight before surgery: If you will receive general anesthesia, you should not eat or drink anything after midnight before the surgery.

• Keep the surgical area clean: Wash your knee thoroughly and wear clean clothes before surgery.

After surgery, pain, swelling, and bruising may occur in the knee. These symptoms usually decrease within a few days. Your doctor may recommend using painkillers and keeping your knee elevated.

You should avoid straining your knee and lifting heavy objects during the first few days. You can begin exercises and physical therapy as advised by your doctor.

The recovery process varies from person to person, but most people can return to normal activities within 6-9 months. Athletes may require a longer time to return to sports.

Cruciate ligament surgery is generally a safe procedure, but like any surgery, it carries some risks. Possible complications include:

• Infection: An infection may develop at the surgical site.

• Bleeding: Bleeding can occur during or after surgery.

• Nerve damage: Although rare, nerve damage may occur.

• Blood clotting: Blood clots (deep vein thrombosis) may develop in the legs.

• Knee stiffness: Stiffness and limited movement in the knee may develop.

• Graft failure: The tendon graft may not properly integrate.

These complications are rare and usually treatable. Your doctor will inform you about potential risks and complications before the surgery.

Follow your doctor’s instructions: Adhere to your doctor’s guidelines regarding post-operative care, medication use, and exercises.
Attend physical therapy: A physiotherapist will teach you exercises to help regain your knee’s range of motion and strength.
Manage pain: Use painkillers and cold compresses to control pain.
Reduce swelling: Elevate your leg and apply cold compresses to decrease swelling.
Watch for signs of infection: If you notice redness, swelling, pain, or discharge at the surgical site, contact your doctor immediately.

• How long does the surgery take?
  Cruciate ligament surgery usually lasts 1-2 hours.
• When can I return to work after surgery?
  The return-to-work time depends on your job and recovery process. Generally, you can return within 1-4 weeks.
• When can I return to sports after surgery?
  The return-to-sports time varies based on the type of surgery, your recovery, and the sport. Usually, you can return to sports after 6-9 months.
• Are surgical scars permanent?
  Surgical scars fade over time but may not disappear completely.
• Will I have pain in my knee after surgery?
  Mild pain after surgery is common but can be managed with painkillers.

Cruciate ligament surgery is an effective method for treating torn or damaged cruciate ligaments. By paying attention to preoperative preparation and postoperative care instructions, you can have a successful surgery and a speedy recovery.