ACL Surgery
Repair a common knee injury.
Anterior Cruciate Ligament (ACL) Surgery is a procedure that doctors use to repair or reconstruct a torn Anterior Cruciate Ligament (ACL) in your knee. The ACL is an important soft tissue band inside your knees. It performs the function of connecting the femur bone to the tibia. It stabilizes your knee. Consequently, when it’s damaged, you may not be able to put pressure on your knee, walk, run or participate in sports. An ACL injury is significantly common in athletes as they make movements that can put a lot of sudden pressure on their knees. These movements include:
- Changing directions rapidly
- Pivoting around your foot
- Landing wrong after a jump
- Stopping abruptly
If the ACL injury is only slight, it may heal itself over time with the help of your doctor and physical therapist. You may also have to take medications, including painkillers. However, if the ACL is torn completely, you may need to get it replaced. This is when you will be opting for ACL reconstruction surgery—especially if you are young and want to maintain an active lifestyle. Athletes almost always go for surgery as they want to keep playing sports. Meanwhile, if you are older or less active, your doctor may recommend you some treatments other than surgery.
During ACL surgery, a torn ligament is replaced with a tissue graft to mimic the natural ACL. The best strategy for ACL Surgery is to adopt an interdisciplinary approach involving all the relevant professionals, including sports medicine physicians, orthopedic surgeons, physiatrists, and radiology and rehabilitation professionals. All these professionals collaborate and work closely with each other to decide and execute the best treatment option for each patient.
When is an ACL Surgery Necessary?
The basic purpose of an ACL surgery is to stabilize your knee to a normal or almost normal extent so that it can function like it used to do before the injury. The surgery also aims to limit the loss of function and prevent damage to other structures in the knee area.
Surgery is usually recommended if:
- You have a completely torn ACL or a partial tear with an unstable knee.
- Other management methods such as physiotherapy and medications didn’t work.
- You are in a profession that demands strong knees and stability, such as construction work.
- You are active in sports.
- Have a chronic ACL deficiency restructuring your knee from performing optimally.
- Other knee structures such as cartilages, meniscus, or other ligaments are damaged.
On the other hand, you may not go for ACL Surgery in the following cases:
- The ligament tear is minor or minimal.
- Your work or daily routine doesn’t require a stable knee.
- You are not into sports or athletics.
- You can afford to stop and substitute doing activities or decrease their intensity if they require a stable or strong knee.
- You can complete a long rehab program aimed at stabilizing and strengthening your knee.
- Lack of motivation for surgery
- Other medical conditions increasing the risk of surgery
What Are the Different Types of ACL Surgery
ACL surgery is usually divided into three types based on the graft used. A graft is a tendon used to replace the torn Anterior Cruciate ligament (ACL).
- Autograft: when the tendon used as a graft is taken from somewhere else in your body like from the other know or thigh.
- Allograft: The graft used is derived from someone else, such as a deceased donor
- Synthetic Graft: This is when artificial materials are used to replace the torn ligament. Silk and silver fibers have traditionally been used as those materials. Nowadays, advanced options such as a Telpon and carbon fibers are available. However, the research is on to find the best artificial material to replace a torn ACL.
What is the Procedure for an ACL Surgery?
Arthroscopic surgery is the technique usually used for your ACL surgery. During arthroscopic surgery, surgeons insert tiny tools and a camera through small cuts in your knee area. The purpose is to leave as minimum scars as possible.
The duration of the surgery is usually one hour. Surgery can be performed by giving general anesthesia or regional anesthesia. In general anesthesia, you are put to sleep through the surgery. Meanwhile, during regional anesthesia, anesthetic medications are injected into your back, and you may be awake while your legs are unable to feel anything. Other medications to keep you relaxed may also be required during regional anesthesia.
During surgery, first of all, the graft is placed at the right spot. Then, surgeons drill two holes, one above the knee and one below. The holes are also called tunnels. And their purpose is to keep the graft in place. It acts like a bridge through which a new ligament heals. A new ACL can take months to grow fully.
Your doctor may discharge you from the hospital the same day after surgery. The usual advice prescribed after the ACL surgery is:
- Stay off your leg
- Rest your knee
- Wear the brace to protect the operated knee
There is ongoing research and trials on a new type of surgery to determine its effectiveness as compared to standard arthroscopic surgery. This new type has been termed as bridge-enhanced ACL repair (BEAR).
Unlike standard ACL surgery, BEAR doesn’t involve replacing their torn ligament with a newer one. Instead, this technique is based on helping the torn ACL heal itself. During the process, a special tiny sponge is inserted between the torn ends of the ligaments. Then the doctors inject your own blood into that sponge. After this, torn ends are stitched loosely into the sponge. Over time, the torn ends heal and turn into a new and healthy ACL.
How Much Does ACL Surgery Cost?
The price of extractions varies depending on the clinic and the complexity of the case. Below is a list of prices you can expect to pay in various countries.
| ACL Reconstruction Surgery Cost Table | |
|---|---|
| Country | Price |
| United States of America | $24,707 |
| Mexico | $4,500 |
Price based on “What Are the Primary Cost Drivers of Anterior Cruciate Ligament Reconstruction in the United States? A Cost-Minimization Analysis of 14,713 Patients” and internal data at Apollo Medical Travel.
What Are the Risks Associated with ACL Surgery?
The general risks that need to be taken care of during any type of surgery are:
- Bleeding
- Hypovolemia
- Shock
- Infection
- Difficulty in breathing
- Formation of blood clots
- Anesthesia problems
Other than these general risks, the specific potential risks associated with ACL Surgery are:
- Persistent Knee pain
- Stiff knee
- A graft not healing well
- Failure of the graft when you try to resume your physical activities
- Damage to other ligaments or menisci
Conclusion
If you are suffering from an acute ACL injury or have been feeling it for a time, it’s time to consult your doctor. Your doctor will take a complete history of your complaints and will examine the knee. They will also run some baselines and diagnostic tests to confirm the ACL injury and its extent.
Additional Resources
Sources
- Middleton KK, Hamilton T, Irrgang JJ, Karlsson J, Harner CD, Fu FH. Anatomic anterior cruciate ligament (ACL) reconstruction: a global perspective. Part 1. Knee Surg Sports Traumatol Arthrosc. 2014;22(7):1467-1482. doi:10.1007/s00167-014-2846-3
Read on PubMed - Paschos NK, Howell SM. Anterior cruciate ligament reconstruction: principles of treatment. EFORT Open Rev. 2017;1(11):398-408. Published 2017 Mar 13. doi:10.1302/2058-5241.1.160032
Read on PubMed - Hoogeslag RAG, Brouwer RW, Boer BC, de Vries AJ, Huis In ‘t Veld R. Acute Anterior Cruciate Ligament Rupture: Repair or Reconstruction? Two-Year Results of a Randomized Controlled Clinical Trial. Am J Sports Med. 2019;47(3):567-577. doi:10.1177/0363546519825878
Read on PubMed - Mahapatra P, Horriat S, Anand BS. Anterior cruciate ligament repair – past, present and future. J Exp Orthop. 2018;5(1):20. Published 2018 Jun 15. doi:10.1186/s40634-018-0136-6
Read on PubMed - Rousseau R, Labruyere C, Kajetanek C, Deschamps O, Makridis KG, Djian P. Complications After Anterior Cruciate Ligament Reconstruction and Their Relation to the Type of Graft: A Prospective Study of 958 Cases. Am J Sports Med. 2019;47(11):2543-2549. doi:10.1177/0363546519867913
Read on PubMed - Paessler HH, Mastrokalos DS. Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. A new and innovative procedure. Orthop Clin North Am. 2003;34(1):49-64. doi:10.1016/s0030-5898(02)00070-6
Read on PubMed - Murray MM, Kalish LA, Fleming BC, et al. Bridge-Enhanced Anterior Cruciate Ligament Repair: Two-Year Results of a First-in-Human Study. Orthop J Sports Med. 2019;7(3):2325967118824356. Published 2019 Mar 22. doi:10.1177/2325967118824356
Read on PubMed - Shelbourne KD, Patel DV. Timing of surgery in anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc. 1995;3(3):148-156. doi:10.1007/BF01565474
Read on PubMed - Bokshan SL, Mehta S, DeFroda SF, Owens BD. What Are the Primary Cost Drivers of Anterior Cruciate Ligament Reconstruction in the United States? A Cost-Minimization Analysis of 14,713 Patients. Arthroscopy. 2019;35(5):1576-1581. doi:10.1016/j.arthro.2018.12.013
Read on PubMed
This article is intended for informational purposes only. It is not meant to be used as medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you have surrounding a medical condition. Never disregard professional medical advice or delay in seeking it as a result of anything you read on this Site.
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