Your physical activity level helps your NYU Langone orthopedic surgeon decide whether you are a good candidate for surgery to reconstruct or repair a torn anterior cruciate ligament (ACL). If you play contact sports like football or sports such as basketball that require you to rapidly pivot on your feet, surgery may be the best treatment option for you.
However, if your physical activity mostly involves walking, or workouts on the elliptical machine at the gym, which do not place large amounts of rotational stress on your knees, your doctor may recommend trying nonsurgical treatments first to help you regain knee function. If symptoms of knee instability and interference with daily activities persist, you and your doctor may then discuss moving forward with ACL surgery.
ACL reconstruction is performed by our highly skilled, fellowship-trained surgeons and is the standard treatment for active patients. Our orthopedic surgeons use the latest surgical advances and reconstruction techniques to ensure you can return home shortly after the procedure to begin your recovery.
Our surgeons specialize in arthroscopy, a minimally invasive approach to outpatient ACL reconstruction. Arthroscopy involves making two or three small incisions in the knee, rather than one or more larger incisions. A tiny camera and fiber optics to light the surgical area are inserted through one of these incisions—these provide doctors with a live and full view of the damaged ligament and the rest of the knee on a video monitor. Arthroscopy may result in less postoperative pain, better mobility after surgery, and a shorter hospital stay than conventional surgery does.
For ACL reconstruction, surgeons remove the damaged ligament with small, specialized surgical instruments. They attach a tissue graft with fixation devices such as screws or anchors to the tibia and the femur, creating a new ligament.
To help with the overall stability of the joint and its ability to rotate, our surgeons may create tunnels in the femur and tibia to help them precisely place the fixation devices and tissue graft.
For the procedure, our anesthesiology team may offer you a regional nerve injection, also called a nerve block, to numb the leg, or spinal anesthesia that numbs the body from the waist down. General anesthesia may also be an option. Our doctors discuss which approach is best for you.
For the surgery, your orthopedic surgeon creates a new ACL out of a piece of tissue, also known as a graft. The graft is most commonly taken from a healthy portion of your injured knee. Tissue used from your own body, called an autograft, may be recommended if you want to return to significant physical activity or pivoting sports.
The autograft typically comes from one of three areas: your patellar tendon, which connects the kneecap to the tibia, or shinbone; the quadriceps tendon, which connects the four muscles in the front of your thigh to the kneecap; or the hamstring tendons, which connect one of the large muscles in the back of your leg to the tibia. The surgeon makes a 4- to 7-centimeter incision to remove the tissue graft. You may experience some pain because of this incision after the operation, but this does not impact overall recovery.
Another option is to reconstruct the ligament using a donor graft. This tissue is screened to ensure it is healthy. Your doctor talks about the benefits and risks of each type of graft reconstruction with you.
You may need to wear a brace for two to six weeks as you heal after autograft ACL reconstruction surgery. Using crutches for one to four weeks may also be necessary to keep weight off your knee and to help swelling subside.
You may need less immediate recovery time after donor graft ACL reconstruction because you do not need the additional incision to remove your own graft tissue.
Most patients typically begin range of motion exercises immediately after surgery and start a comprehensive physical therapy program within a week of the procedure. Our physical and occupational therapists can help you with this recovery process.
Your doctor may discuss the option of ACL repair surgery, a procedure that reattaches the torn ligament to bone, based on the tear patterns found on your MRI scans. Patients with tears in the ligaments that attach to the femur or tibia may be candidates for this kind of surgery.
Benefits of ACL repair surgery include a shorter recovery time and the ability to return to sports more quickly. The procedure does not require taking a tissue graft from elsewhere in your knee.
Technological advancements in implants, surgical techniques, and biologics—such as platelet-rich plasma (PRP) injections containing growth factors that can stimulate healing—complement ACL repair and have created renewed interest in this procedure.
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