ACL Reconstruction
Description: Anterior Cruciate Ligament (ACL) reconstruction is a surgical procedure to replace a torn ACL, which is a critical ligament for knee stability. This surgery is common among athletes and individuals with active lifestyles. The procedure typically involves using grafts from the patient’s own body (autografts) to create a new ligament. The two primary types of grafts used are hamstring tendon grafts and quadriceps tendon grafts. Here is a detailed description of each approach:
Quadriceps Tendon Graft
Procedure:
- Harvesting the Graft: The surgeon makes an incision over the top of the knee to access the quadriceps tendon. A portion of the tendon is harvested (a newer technique than the one shown in the video above).
- Preparing the Graft: The quadriceps tendon graft is prepared.
- Tunnel Creation: Similar to the hamstring graft, tunnels are drilled in the femur and tibia to accommodate the new ligament.
- Graft Placement: The quadriceps tendon graft is placed through the tunnels and secured with screws or other fixation devices.
- Closure and Recovery: The incisions are closed, and the knee is bandaged. The patient is then taken to recovery to start the rehabilitation process.
Hamstring Tendon Graft
Procedure:
- Harvesting the Graft: The surgeon makes a small incision on the inner side of the knee to access the hamstring tendons. Typically, the semitendinosus tendon, and sometimes the gracilis tendon, are harvested.
- Preparing the Graft: The harvested tendons are folded over to create a stronger, multi-strand graft. This graft is then prepared and sized to fit the patient’s knee.
- Tunnel Creation: The surgeon drills tunnels in the femur (thigh bone) and tibia (shin bone) where the ACL was originally located. These tunnels will hold the graft in place.
- Graft Placement: The hamstring graft is threaded through the tunnels and secured with screws or other fixation devices to ensure stability.
- Closure and Recovery: The incisions are closed, and the knee is bandaged. The patient is then taken to recovery to begin the rehabilitation process.
Recovery from ACL reconstruction involves a structured rehabilitation program that spans several months. The goals are to restore knee range of motion, strength, and stability, and to gradually return to normal activities.
Immediate Postoperative Phase (Weeks 1-2):
- Focus on reducing swelling and pain.
- Gentle range-of-motion exercises.
- Begin weight-bearing as tolerated with the aid of crutches.
Early Rehabilitation Phase (Weeks 3-6):
- Increase range-of-motion exercises.
- Begin strengthening exercises, focusing on the quadriceps and hamstrings.
- Gradual increase in weight-bearing activities.
Intermediate Rehabilitation Phase (Weeks 7-12):
- Continue strengthening exercises.
- Introduce balance and proprioception exercises.
- Gradual return to low-impact activities.
Advanced Rehabilitation Phase (Months 3-6):
- Focus on advanced strength and functional training.
- Gradual return to sports-specific activities.
- Continue working on agility and coordination.
Return to Sports (Months 6-12):
- Full return to sports and high-impact activities.
- Ongoing strength and conditioning to prevent re-injury.
This question varies a lot on what you do, and any accommodations that can be made for you at work and at home. Most importantly is depends on you – your expectations, drive and recovery are all variable. Most “desk” type jobs can be resumed around 8-12 weeks later, sooner in some cases. Most physical jobs will need a stronger recovery, typically 3-4 months.
You may drive when:
1) You are no longer taking narcotic pain medication
2) You have full power and function to engage in emergency braking of your car if necessary.
This usually takes a minimum of 6 weeks.
The main goal of ACL reconstruction is a return to all day-to-day activities and recreational activities. For recreational activities, you may return to activities such as skating, skiing, weight lifting, swimming, bowling, golfing, tennis, squash, biking, and using an elliptical trainer after 6 months. Realistically there are no restrictions long term after having your ACL reconstructed.
Ideally, flying and long-distance travel should be postponed until six weeks after surgery. Short flights and travel can be undertaken 1-2 days post-surgery, but it’s important to get up and move every hour and to use a prescribed blood thinner.
Your physical condition is the biggest factor affecting your travel. You may still need a walker or cane to move safely and navigating crowded areas can be challenging. Planes, buses, and trains are often cramped, and sitting for extended periods can cause stiffness and knee pain.
In summary, if you can delay travel for the first six weeks, you will likely enjoy your trip more. Short flights, especially those necessary for returning home after surgery, should not be taken before 1-2 days and will require a prescribed blood thinner.
