Knee stability is a function of the knee ligaments. The anterior cruciate ligament (ACL) is the primary knee stabilizer. It connects the femur or upper leg bone with the tibia, or shin bone, and keeps the tibia in its correct position, prevents the femur from moving out of place during weight bearing, and prevents rotation of the joint, or rotational stability.
Most injuries to the ACL involve no impact. Rather, ruptures often occur from pivoting, twisting, decelerating suddenly and landing from a jump. Injury to the ACL is especially common in sports like football, basketball, and skiing. Ruptures cause pain, instability and altered function, including buckling of knee, difficulty extending the leg, and bleeding into the joint, which significantly restricts movement. Frequently an ACL injury is accompanied by damage to the meniscus and the other ligaments.
High risk, high impact sports put the athlete’s ACL at risk for injury. When the patient seeks to return to high level sports, reconstruction is often necessary. Repair surgery is not done.
Diagnosing the rupture
The patient and Dr. Thomas will discuss the injury, and receive a physical examination by Dr. Walter Thomas. An MRI will confirm the tear, and reveal any additional damage to the meniscus or other ligaments. If the meniscus is damaged, surgery is always recommended.
When there is a complete tear or rupture, the ligament cannot be repaired and loses all function. Within a few months, the ligament will breakdown and be absorbed by the body.
What is ACL Reconstruction?
Reconstruction is an arthroscopic, minimally invasive, surgical procedure to rebuild the ligament with a tissue graft. During the surgery the ruptured ACL is removed, and a surgical tissue graft commonly made from a patient’s tendon in the knee cap or hamstring is used to replace it. This is called an autograft. When needed, the tissue may be obtained from a deceased donor, called an allograft. The graft is a scaffold on which new ligament tissue will grow.
When is ACL reconstruction recommended?
- An athlete wants to continue to play her chosen sport, particularly if that sport involves jumping, twisting and pivoting
- There is persistent knee instability
- More than one ligament or cartilage is injured
- The patient is young and active, and
- The injury causes your knee to buckle during normal activities.
ACL Surgery is an outpatient procedure, done under general or regional anesthesia. Once the patient is anesthetized, the tissue graft that has been selected will be will be obtained and prepared for insertion.
Several small incisions or portals are made in different areas of the knee. In the portal at the front of the knee, an arthroscope, a small, thin tube containing a fiber optic video camera, is inserted into the knee so that Dr. Thomas can visualize the damage. In another portal, small surgical tools are inserted to remove the damaged tissues are inserted. Dr. Thomas will remove the damaged ligament. Small holes will be drilled into the tibia and femur, the graft will be inserted, and attached with biodegradable screws. Dr. Thomas will test the knee’s range of motion, and check to assure the graft is secure. The tiny incisions will be closed with absorbable sutures, and the knee will be put into a brace to stabilize it.
Most patients will be able to go home the same day. Before you leave the surgery center you will receive crutches and a knee brace for home use.
Patients will receive specific instructions on how to care for the surgical area, when to shower or bathe, when to change wound dressings and generally how to manage post-surgery care. Pain relievers will be offered to address pain and soreness. Patients will receive additional instructions after the procedure including information on restricted activities for a few months, walking on crutches, and wearing a knee brace. Generally, patients will be instructed to use the noninvasive conventional care, rest, ice, compression and elevation after surgery.
Importantly, patients will be instructed to participate in progressive physical therapy to strengthen the muscles around the knee and to improve flexibility. Your rehab plan is essential to proper healing and the best outcome.
The goal of surgery is to restore stability and function including range of motion. Athletes can often return to sports 6-12 months after surgery.
As with all surgery, bleeding and infection are potential risks.
For patients Southern California who are in pain due to an injury or arthritis, Thousand Oaks Dr. Walter Thomas, MD can help. He is a compassionate, kind and caring orthopedic surgeon who will treat you as if you were a member of his family. Dr. Thomas emphasizes injury prevention, and will educate you so you can return to your sport of choice at the highest level of play. His goal is to get you back to your passion, whether sports or chasing after your children.
Schedule a consultation with Dr. Thomas and find out how you can get relief today. Call us at 805- 497-0817.