Anterior cruciate ligament reconstruction

What is a torn anterior cruciate ligament (ACL)?

A torn anterior cruciate ligament (ACL) is a condition where one of the four ligaments responsible for knee stability is damaged. This ligament connects the shinbone (tibia) to the thighbone (femur). The ACL can tear as a result of a twisting motion of the knee, often occurring during sports activities involving pivoting and cutting movements, such as hockey, soccer, and tennis. A torn ACL is a serious knee injury that often involves concurrent injuries such as meniscus tears, cartilage damage, and other ligament tears. When the ACL tears, it cannot heal on its own.

What are the symptoms?

If you tear your anterior cruciate ligament (ACL), it may be accompanied by the following symptoms:

A popping sensation in the knee during the twisting injury
Pain and inability to participate in sports activities
Immediate swelling of the knee
Difficulty in bending and straightening the knee
Instability.

How do we diagnose it?

The diagnosis is made in the examination room during the physical examination. Additional tests are always conducted:

An X-ray: This allows us to quickly assess whether there is a fracture or any signs of degeneration
An MRI scan: This allows us to study all the structures in the knee and determine the extent of the damage.

What does the treatment consist of if you have torn your anterior cruciate ligament (ACL)?

When the anterior cruciate ligament (ACL) is torn, swelling of the knee occurs and it becomes difficult to fully extend and flex the knee. Therefore, the early treatment approach involves taking anti-inflammatory medication to reduce the swelling. It is also recommended to start with physiotherapy to normalize the knee’s range of motion. In a small group of patients, the knee may recover well without the need for surgery. However, for most athletes and patients, instability will persist. That is why a reconstruction of the anterior cruciate ligament is performed.

Anterior cruciate ligament (ACL) reconstruction

If you have decided to undergo surgery, the torn cruciate ligament will be replaced with tissue from your own body. This can be a hamstring tendon, a portion of your patellar tendon, or the quadriceps tendon. The choice of which tendon to use depends on various factors such as other damaged tissues around the knee, the type of sport you engage in, and the level at which you participate in that sport. While donor tissue can also be used, we always aim to use your own tendons whenever possible.

The surgery

The surgery takes place as a day procedure, and you are usually allowed to go home the same day. The operation can be performed under general anesthesia or with a spinal anesthesia, depending on your preference. Often, a local anesthetic is also given in the groin area, known as a femoral block, to minimize pain during the first 48 hours after the surgery.

During the operation, the following steps are carried out:

First, the tissue (hamstring tendons, quadriceps tendon, or patellar tendon) is harvested to create the new cruciate ligament.
A knee arthroscopy is performed to inspect the entire knee. If there is any meniscus or cartilage damage, it can be treated.
The remnants of the old anterior cruciate ligament are removed, and tunnels are drilled in the thigh bone (femur) and shinbone (tibia).
The newly harvested tissue is placed in the tunnels and secured as the new cruciate ligament.
The instruments are removed, and the skin is closed with absorbable sutures.

What does the rehabilitation process look like?

After the surgery, you will need to use crutches for 4 to 6 weeks. A few days after the operation, under the guidance of a specialized physiotherapist, you will begin rehabilitation to build strength, train stability, and restore knee mobility. The total rehabilitation period for an anterior cruciate ligament (ACL) reconstruction typically takes about 1 year. This is because the new ligament needs time to “grow” into the knee through a biological process. Additionally, you will need to train diligently to restore muscle conditioning, which usually takes about 6 months. However, except for sports activities, after 6 weeks, you should be able to resume most daily life activities.