ACL – Anterior Cruciate Ligament Reconstruction

What is the ACL?

The anterior cruciate ligament (ACL) is one of the four ligaments most athletes know by name and dread hearing that they’ve torn it. The good news for anyone with a torn ACL is that the techniques to repair and reconstruct the ACL have improved and advanced considerably in the past decade. A torn ACL is no longer career-ending for most athletes and many are able to return to the sport that they love.

The ACL is one of the four major ligaments in the knee. It runs through the center of the knee from the front of the tibia (shin bone) to the back of the femur (thigh bone). The ACL is responsible for stabilizing the knee joint by keeping the tibia from sliding out in front of the femur. Dr. Benedict Nwachukwu, complex knee surgeon serving Manhattan, New York City and the surrounding New York Boroughs has extensive experience in treating the ACL and other knee ligament injuries.

What is an ACL Injury?

An ACL injury or tear can occur from a sudden stop, a change in direction or from planting the foot and pivoting sharply. Most seen in athletes who participate in sports like soccer, tennis, football, basketball and gymnastics, an ACL tear usually requires reconstruction surgery.

Many individuals in the New York area hear a “pop” and experience immediate pain, swelling and knee instability. Dr. Nwachukwu recommends ACL reconstruction because the ligament cannot heal on its own. Reconstruction restores the patient’s knee function and mobility.

What is ACL Reconstruction?

An anterior cruciate ligament reconstruction is a surgical technique that replaces the torn ACL with a tissue graft. During this procedure, the torn ligament is removed and a new graft is inserted. There are two types of ACL tissue grafts that may be used for this surgery:

• Allograft: Tissue is harvested from a donor, usually a cadaver. The sources for the graft may come from the donor Achilles tendon, patella, or quadriceps tendon.
• Autograft: Tissue is harvested from the patient. The patellar tendon, hamstring or quadriceps tendon may be used to reconstruct the ACL.

How is ACL reconstruction done?

An ACL reconstruction is usually done arthroscopically using a small surgical camera and small, specialized instruments. During this procedure, Dr. Nwachukwu will first obtain a tissue graft from the patient, or from a donor. The following steps are then taken:

• The new tendon is prepared with anchor points called “bone plugs” which will graft the tendon into the knee.
• A small incision is made in the front of the knee and the arthroscope is placed.
• The inside of the knee is prepared with saline solution to allow Dr. Nwachukwu to see the knee structures.
• Small holes are drilled into the tibia and femur so the bone plugs can be attached.
• The ligament is then attached at the drill sites.
• Nwachukwu then tests the knee’s range of motion and the tension of the graft to make sure it is secure.
• Instruments are removed from the knee and the incision is stitched.
• The knee is dressed and wrapped, then immobilized with a brace.
• Patients can usually go home the same day as the surgery.

What is the difference between ACL repair and ACL reconstruction?

Orthopedic medicine and the introduction of minimally invasive techniques have revolutionized the treatment of many knee injuries. Understandably, techniques used in 1980, such as an ACL repair have improved and evolved. ACL repair was the standard of care for a torn ACL 40 years ago, however the outcomes for a repair were poor and many patients were unable to return to sport, nor did they regain complete knee function. Today’s orthopedic surgical treatments which involve arthroscopic techniques for reconstruction and repair, has given patients in New York better surgical outcomes.

Although ACL reconstruction is the preferred technique in most cases of ACL injury, there can be a role for ACL repair. New techniques involving arthroscopic surgery techniques and biologic medicine have shown new promise in the success of a repair for a specific type of injury pattern or tear. Long term outcomes for these are still unclear but ACL repair may be a consideration in select types of ACL injury. Dr. Nwachukwu will carefully discuss all of the best treatment options for patients in New York with an ACL tear.

What happens after ACL reconstruction?

The ACL reconstruction is usually done as an outpatient with the patient going home the same day. The patient will be given pain medication as well as instructions for ice, elevating the knee and for rest.

It is important to follow Dr. Nwachukwu’s post-surgical protocol which will specify how long to use crutches and when it’s safe to bear weight on the knee. Exercises will be given which will progress to physical therapy and eventually, strengthening exercises.

How long is the recovery from ACL reconstruction?

As with any ligament surgery, recovery time will vary depending on whether other surgeries needed to be performed in addition to the ACL reconstruction. The patient’s own goals and willingness to complete a thorough post-surgery protocol also play an important roll in the recovery. In general, most patients with a simple ACL reconstruction can return to work or school in as little as 5 days, with some minor restrictions. Physical therapy is started immediately after reconstruction and a careful, individualized rehabilitation plan is prescribed by Dr. Nwachukwu. Between weeks 6 and 12, fitness activities can resume, with a full return to sport in about 7 to 9 months.

For more information on ACL Reconstruction, anterior cruciate ligament treatment, or to discuss treatment options for your knee injury, please contact the office of Benedict Nwachukwu, MD, orthopedic knee surgeon serving Manhattan, New York City and the surrounding New York boroughs.