What is anterior cruciate ligament (acl) surgery ?

The anterior cruciate ligament (ACL) is one of four knee ligaments that connect the upper leg bone (femur) with the lower leg bone (tibia). When you injure or tear your ACL, your knee is less stable. It may "give out" when you do not expect it and then become stiff and swollen.

Surgery can help your knee feel better. But in some cases, the knee may not be as strong as before it was injured.

This type of surgery replaces your damaged ACL with a new one. The new one is called a graft. Most of the time, the graft is a tendon taken from your own knee or hamstring. But it may come from a donor.

After surgery, most people can return to their normal activities.

The goal of ACL surgery is to:

• Restore normal or almost normal stability in the knee.
• Restore the level of function you had before the knee injury.
• Limit loss of function in the knee.
• Prevent injury or degeneration to other parts of the knee.

Your doctor makes several small cuts (incisions) around the knee. Then the doctor puts a lighted tube, called an arthroscope or scope, into one of the incisions. A camera at the end of the scope sends pictures from inside the knee to a TV monitor in the operating room. The doctor watches the monitor to do the surgery.

The doctor puts surgical tools through the other incisions. Small holes are drilled into the upper and lower leg bones where these bones come close together at the knee joint. The holes form tunnels for the graft. The doctor takes the graft and pulls it through these tunnels. Then the doctor attaches the graft with screws or staples.

Next the doctor closes the incisions with stitches or tape. And you may get a temporary surgical drain placed in your knee.

You will not feel pain during the surgery. You will get medicines to make you sleep or to numb your leg.

Your doctor also may repair other injured parts of your knee. These may include ligaments, cartilage, or broken bones.

Most people who have ACL surgery have reduced pain, good knee stability, and a return to normal activities. But some still have knee pain and instability. A few people may need another surgery (revision ACL reconstruction). Revision ACL reconstruction is generally not as successful as the initial ACL reconstruction.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You will have a chance to talk to your physical therapist. Physical rehabilitation is a big part of your recovery. Your therapist may teach you some exercises that will help prepare your knee for surgery.
• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. Sleep with your knee raised, but not bent. Put a pillow under your foot. Keep your leg raised as much as you can for the first few days.
• You can use a brace and crutches to move around the house to do daily tasks. Don't put weight on your leg without these until your doctor says it's okay. Your thigh muscles will be weak, so take your time and be safe. You will have the crutches for 1 to 2 weeks.
• If you have a brace, leave it on except when you exercise your knee or you shower. (Not all doctors use braces.) Be careful not to put the brace on too tight. You will probably need to use it for 2 to 6 weeks.
• For about 12 weeks, do not do any strenuous activity. This includes not only sports, but also things like mowing lawns, raking leaves, and shoveling snow.
• You may shower 24 to 48 hours after surgery, if your doctor okays it. When you shower, keep your bandage and incision dry by taping a sheet of plastic to cover them. It might be best to get a shower stool to sit on. If you have a brace, only take it off if your doctor says it's okay.
• If your doctor does not want you to shower or remove your brace, you can take a sponge bath.
• Do not take a bath, swim, use a hot tub, or soak your leg for 2 weeks or until your doctor says it's okay.
• You can drive when you are no longer using crutches or a knee brace, are no longer taking prescription pain medicine, and have some control over your knee. For most people, this takes 1 to 2 weeks.
• How soon you can go back to work depends on your job. If you sit at work, you may be able to go back in 1 to 2 weeks. But if you are on your feet at work, it may take 4 to 6 weeks. If you are very physically active in your job, it may take 4 to 6 months.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt. Drink plenty of fluids.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. They will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Incision care

• If you have a bandage over your incision, keep the bandage clean and dry. Follow your doctor's instructions. Your doctor will probably want you to leave the bandage on until you come back to the office. If your doctor allows it, you may be able to remove the bandage 48 to 72 hours after your surgery.
• If you have strips of tape on the incision, leave the tape on for a week or until it falls off. Keep the area clean and dry.

Exercise

• Do your rehab exercises as instructed. Exercise in a rehab program is an important part of your treatment. It will help you improve your knee's range of motion and regain your muscle strength.
• If you are given a continuous passive motion machine, use it as directed. This machine will do some of the exercises for you. You will use it for about 2 weeks.

Ice and elevation

• Put ice or a cold pack on your knee for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake). Put a thin cloth between the ice and your skin. If your doctor recommended cold therapy using a portable machine, follow the instructions that came with the machine.
• For 3 days after surgery, prop up the sore leg on a pillow when you ice it or anytime you sit or lie down. Try to keep it above the level of your heart. This will help reduce swelling.
• If your doctor gave you support stockings, wear them as long as you are told to.