Understanding When Surgery is Right – ACL

From total knee replacements to small meniscus tears, I see knee injuries all the time. Another common knee injury is a torn ACL, an injury that usually requires surgical correction. In this article I’m going to explain what an ACL tear is and what factors are in play when deciding whether or not surgery is necessary.


Intro to the ACL. Your anterior cruciate ligament (ACL) is the primary stabilizing ligament of the knee joint. It connects the femur (thigh bone) to the tibia (shin bone) and is one of the most commonly injured ligaments in the knee.


Tearing your ACL (as you can imagine) is very painful. This injury causes swelling, knee instability, and loss of motion. After tearing your ACL, you will likely have a hard time getting around. Without its main stabilizing ligament, your knee is more likely to give out, making it hard to walk.


ACL Surgery. Sometimes, even after tearing their ACL, patients can walk without much issue. Don’t be fooled though﹘ your ACL cannot heal on its own. Unless you are extremely inactive and your knee doesn’t give out while walking or exercising, I recommend surgically repairing the ligament.


Due to the natural structure of the ACL, they are difficult to repair without using extra tissue. Usually, I reconstruct the joint using additional tissue either from the patient’s body (an autograft) or a cadaver (an allograft). Both methods are very effective for repairing the ligament.


Patients who receive autografts are less likely to tear their ACL again, but the procedure is more painful because their tissue has to be harvested for the procedure. Allografts are less painful but carry with them the (very low) chance of contracting communicable diseases or the body rejecting the new tissue. I usually let my patients choose whether they want an allograft or an autograft.


What to Expect. Unlike other orthopaedic emergencies, ACL surgery can happen a few weeks after the initial injury. Before I can fix anything, the knee inflammation has to subside and the patient must see a physical therapist to ensure their joint has full range of motion. If you don’t wait until the initial pain and swelling go down, you will have a longer, more painful recovery period after your surgery.


Right before your procedure, we administer a local anesthetic to the affected knee and give you general anesthesia. The local anesthetic allows us to give less general anesthesia, which is always the safer option. After you’ve been put under, I use an arthroscope (tiny camera) to see inside the knee. With this amazing technology, the whole surgery can be performed through three small incisions in the knee.


After your surgery is complete, you can expect to go home the same day with an ice machine that cools and compresses your knee and a continuous passive motion (CPM) machine to restore the range of motion in the joint.


Recovery time is quick﹘ you can return to sedentary activities (school, desk job) after two or three days. You’ll be using crutches for a couple of weeks and a brace for up to four weeks after the procedure. In order to maintain strength and range of motion, you will start a rigorous physical therapy regimen beginning the day after your surgery.


You should wait at least six months before playing any contact sports. A graft can take up to a year and half to fully incorporate with your tissue, so I recommend wearing an ACL brace for the full duration of your healing.