Anterior Cruciate Ligament (ACL) Reconstruction Surgery
An Anterior Cruciate Ligament (ACL) injury is a common injury among individuals who play sports. When you have a healthy ACL, it works effectively to hold the bones of your knee together. It also keeps your knee stable. When there's damage to it, however, you might have difficulty applying pressure on your knee, playing sports and walking. If you slightly tear or strain your ACL, it might heal over time with physical therapy and your doctor's help.
What is the Anterior Cruciate Ligament (ACL) and What Does it Do?
The Anterior Cruciate Ligament (ACL) is tissue connecting your shinbone and thighbone at your knee. Many ACL injuries happen during sports like:
Treatment might include physical therapy and surgery.
Common Causes of an ACL Injury
Most types of ACL injuries occur through non-contact factors. A small percentage is due to direct contact with another object or player. The injury mechanism is often linked with deceleration together with:
- "Out of control" play
- Awkward landings
- Sidestepping maneuvers
A few studies have shown women athletes experience more ACL injuries than men athletes in certain types of sports. It's been suggested this is because of differences in muscular strength, physical conditioning, and neuromuscular control. Other theories on causes of this include:
- Increased ligamentous laxity
- Lower extremity (leg) and pelvis alignment
- Impact of estrogen on ligament properties
Can an ACL Injury Heal on Its Own?
Non-surgical treatments are typically considered first, however, if it's a complete tear with an unstable knee, or if after non-surgical treatment, your knee doesn't heal, you may require surgery. The ACL can't heal by itself since there's no supply of blood to this ligament. Athletes typically require surgery because they require their ACL to safely perform sharp movements required in sports.
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What is an ACL Tear (Signs and Symptoms)?
ACL injuries are tears and sprains of your anterior cruciate ligament (ACL), which as you've learned, is one of your major knee ligaments.
Symptoms and signs of ACL injuries typically include:
- Rapid swelling
- A "popping" sensation or loud "pop" in your knee
- Inability to continue the activity or severe pain
- A feeling of a "giving way" or instability with weight-bearing
- Loss of range of motion
What is ACL Reconstruction Surgery?
ACL injury surgery involves repairing or reconstructing the ACL
ACL injury surgery uses a graft for replacing the ligament. Autografts are the most common grafts which use part of your body like your patellar tendon (tendon of your kneecap) or a hamstring tendon. In some cases, surgeons use the quadriceps tendon which is found above your kneecap. The allograft tissue is another choice, which the surgeon obtains from a deceased donor.
Typically, repair surgery is used in cases when there's an avulsion fracture. This is a separation of the piece of the bone and ligament from the rest of your bone.
Usually, a surgeon performs ACL surgery by making small incisions in your knee and inserting surgical tools through these incisions. This is referred to as arthroscopic surgery. Sometimes, it's performed by making a large incision in your knee — called open surgery.
Orthopedic surgeons perform ACL surgeries.
Patellar Tendon and the ACL Surgery
The standard surgery for fixing an ACL tear is with the patellar tendon graft. The doctor will take the middle section out of your patellar tendon below your patella (kneecap). The new graft will include the tendon strip and attached bone plugs on each end. The doctor will remove the torn ACL, putting the new graft into your knee, ensuring it lines up like the initial ligament.
How Long Does an ACL Surgery Take?
The surgery typically takes less than a couple of hours. It requires the surgeon to make an incision for removing a tendon if you're undergoing an autograft and insert a tendon from a different part of your body into your knee. The surgeon makes a few small punctures for the arthroscope. This is a flexible, thin scope that lets the surgeon see inside your knee. Since the tendon isn't taken from you with an allograft, the procedure is shorter.
The surgeon passes the graft through bone tunnels and fixes it to your femur or upper leg bone and tibia or lower leg bone with posts or screws and stitches.
After the surgeon sews up the incisions, they'll apply a sterile dressing. Following the surgery, they'll bring you to the recovery room.
How Much Does ACL Surgery Cost?
If you have no insurance and you'll be paying for your procedure, be sure to research a little. ACL surgery costs vary widely around the country.
The U.S. national average ACL surgery cost, according to Guroo.com and reported by Healthgrades.com, was around $12,600 in 2016. Costs can vary by location and complexity of the repair.
Is ACL Surgery Covered by Insurance?
Most insurance plans, which include Medicaid and Medicare, cover ACL surgery. If your insurance covers it, the surgeon will have to show it's medically necessary.
How much you pay out-of-pocket for your procedure will depend on your insurance coverage. Even if your procedure is covered by your insurance, you'll likely still need to pay a portion of the cost. Ask your insurance company about things like:
Recovery Time for ACL Surgery
You will spend a brief time after surgery in the recovery room until you're breathing effectively, alert and you have stable vital signs. You'll likely go home the same day as your procedure.
Recovery time is gradual following surgery. You'll have to use crutches and wear a knee brace for a few weeks following your procedure. The surgeon will also refer you to a physical therapist or to an exercise rehab program to help with recovery. The exercises will help build knee strength and restore range of motion.
It could take many weeks for full graft healing. Recovery time will vary depending on:
- The type of anesthesia
- The specific surgery
- Your age
- Your general health
- Other factors
Complete recovery takes a minimum of four to six months, but it could take up to a year. It typically takes a minimum of six months before you can go back to playing sports.
How Long Until I Can Walk/Run After ACL Surgery?
Knee joint physical therapy is separated into four phases. If you follow the instructed protocol provided to you by your surgeon and/or physical therapist, you should be able to start walking again by the end of your third week following your ACL procedure.
Pain and ACL Surgery
The surgeon will give you specific instructions on controlling pain and swelling associated with your surgery. Generally, it's essential you elevate your leg, rest as much as possible and apply ice to your knee.
They might instruct you to take medicine for pain including OTC medications like ibuprofen (Motrin IB, Advil), acetaminophen (Tylenol) and naproxen sodium (Aleve). The surgeon may prescribe you stronger medicines like gabapentin (Neurontin) or meloxicam (Vivlodex, Mobic). If they prescribe opioids, you should only take these for breakthrough pain since they come with a significant risk of dependence and side effects.
How Easy is it to Retear the ACL After Surgery?
There are certain factors that could put you at risk after ACL surgery of a retear that are not within your control like your age and gender. For example younger athletes and female athletes are more susceptible to retears.
There are several reasons an ACL retear could occur after your procedure, such as issues related to:
- Personal issues
An important aspect of the success of an ACL procedure is how well the surgeon positioned the graft inside your knee joint. Not all surgeries are performed with the same level of precision and certain variables could result in problems if the surgeon doesn't properly position the new ACL.
ACL Surgery and Driving
If you're using narcotic medicines, you should avoid driving. If your procedure was performed on your left side and you have an automatic transmission in your vehicle, you might be able to start driving in a couple of weeks. If it was performed on your right side and you have a manual transmission in your car, it might take you four to six weeks before you can drive. Also, you need to be off crutches and have leg control before you can begin driving.
Physical Rehab Following ACL Surgery
Following ACL reconstruction surgery, the doctor will prescribe physical therapy to help you get back to your regular activity level. You'll start exercises while you're still in the hospital. You'll be shown how to:
- Perform the exercises
- Use the equipment
You'll also receive an exercise booklet and instructions. Prior to going home, you'll receive home care instructions as well for the following week and for your post-op PT program. Prior to leaving the hospital, you'll need to have a full understanding of these instructions.
Knee joint physical therapy is separated into four main phases:
- Phase 1: This phase is designed to help heal your knee. The primary goals of this phase are for protecting your knee so it properly heals, to begin working on restoring joint range of motion and to begin restoring regular use of your thigh muscles (quadriceps).
- Phase 2: During this phase, you'll hopefully be able to toss your crutches. You should have the swelling under control and you should have the ability to contact your quadriceps easily. The goal of this phase is stopping the use of crutches and beginning to walk while still keeping your knee protected.
- Phase 3: This phase is designed to get your leg stronger. By the end of this phase, you'll hopefully have progressed from walking to jogging lightly.
- Phase 4: In this phase, you should be almost back to your normal self. You'll go from light jogging to running. It's essential you don't overdo it, even if you feel amazing. You still should hold off on participating in sports that involve a lot of cutting or starting and stopping.
The Best Orthopedic Surgeon in Corpus Christi, Texas for ACL Reconstructive Surgery
At Coastal Orthopedics in Corpus Christi, our orthopedic surgeons realize most people enjoy active lifestyles all year long. However, injuries occur. We don't want an injury to stand in your way of being able to fish, hunt, play sports or live an active lifestyle. We're dedicated to helping you get back to your active life as quickly as possible and will provide treatment that will allow you to leave your injury, pain, and discomfort behind you. Contact our office to set up your ACL reconstructive surgery consultation today.
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