 Knees following ACL reconstruction surgery. A patellar tendon graft was used. Discoloration of the left leg is from swelling that drained from the knee to the shin. Anterior cruciate ligament reconstruction (ACL reconstruction) is surgical repair of a torn anterior cruciate ligament in the knee. Because the ACL does not heal on its own, an ACL reconstruction requires a tissue graft. The torn ligament is removed from the knee before the graft is inserted. The types of surgery differ mainly in the type of graft that is used. In all cases, the surgery is done arthroscopically. A typical modern surgery operation Surgery (from the Greek cheirourgia meaning hand work) is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment. ...
Diagram of the knee The anterior cruciate ligament (or ACL) is one of the four major ligaments of the knee. ...
An x-ray of a human knee In human anatomy, the knee is the leg joint connecting the femur and the tibia. ...
Arthroscopy (also called arthroscopic surgery) is a minimally invasive surgical procedure in which a physical examination of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the join through a small incision. ...
Types of grafts
The patellar tendon connects the patella (kneecap) to the tibia (shin). Generally the graft is taken from the injured knee, but in some circumstances (such as a second operation) the other knee may be used. The middle third of the tendon is used, with bone fragments on each end removed. The graft is then threaded through holes drilled in the tibia and femur, and finally screwed into place. Left patella - anterior aspect Left patella - posterior aspect The patella or kneecap is a thick, triangular bone which articulates with the femur and covers and protects the front of the knee joint. ...
A tendon or sinew is a tough band of fibrous connective tissue that connects muscle to bone. ...
Left patella - anterior aspect Left patella - posterior aspect The patella or kneecap is a thick, triangular bone which articulates with the femur and covers and protects the front of the knee joint. ...
Figure 1 : Upper surface of right tibia. ...
Figure 1 : Upper surface of right tibia. ...
Anterior view of the femur The femur or thigh bone is the longest, most voluminous and strongest bone of the human body. ...
This tendon is large and very strong, and so makes an excellent graft in most patients. A brace often is not even necessary following surgery, so the muscles around the knee have less risk of atrophying from disuse. This option is often used by athletes who wish to return to full performance as fast as possible. Atrophy is the partial or complete wasting away of a part of the body. ...
The disadvantage is that the removal of the patellar tendon is more painful than the other options. Strong painkillers may be prescribed for several weeks following the surgery. The patellar tendon also takes about one year to fully recover; until then, there is an increased risk of tendonitis. For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ...
Tendonitis (also tenonitis or tendinitis) is an inflammation of a tendon. ...
For this procedure, two tendons from the hamstring (generally from the injured knee) are the source of the graft. A long piece (about 25 cm) is removed from each of two tendons. Each piece is threaded through the tibia, around a screw in the femur, and then back to the tibia. Finally, the ends of the loops of tendon are screwed into place in the tibia. Hamstring refers to the common tendon of the muscles making up the ham in animals, primarily the semitendinosus and biceps femoris. ...
A tendon or sinew is a tough band of fibrous connective tissue that connects muscle to bone. ...
Unlike the patellar tendon, the hamstring tendons are not as strong. Therefore, following surgery, a brace is often used to immobilize the knee for one to two weeks while the most critical healing takes place. The removal of hamstring tendons, however, is not as painful as the patellar tendon graft. Evidence suggests that the hamstring tendon graft does just as well, or nearly as well, as the patellar tendon graft in the long-term.
Because this procedure is less painful than the patellar tendon graft, this is often used when a faster recovery is unnecessary. Because the knee must be immobilized for the first week, there is often significant muscle loss, and a long course of physical therapy is necessary to regain strength.
Cadaver An ACL or patellar tendon may be harvested from a cadaver and used as the graft. This method has the benefit that the most painful part of the surgery, the harvesting of tendon tissue, is avoided. However, there is a chance of rejection, which can lead to infection and a need to remove the graft. Therefore, this option is most often used in patients whose health makes harvesting tendon risky.
Recovery All surgeries have a similar long-term recovery time frame. After surgery, most flexibility of the knee joint is lost. Initial therapy consists of stretching to regain the flexibility and prevent scar tissue, and simple exercises to reduce loss of muscle. Often a continuous passive motion machine is used immediately after surgery to help with flexibility.
About three weeks are required for the bone to attach to the graft. After this, the patient can typically walk on their own and perform simple physical tasks without risk. Continued physical therapy is needed regain strength and flexibility.
After four months, more intense activities such as running are possible without risk. After six months, the reconstructed ACL is generally at full strength (ligament tissue has fully regrown), and the patient may return to activities involving cutting and twisting. A ligament is a short band of tough fibrous connective tissue composed mainly of long, stringy collagen fibres. ...
The reconstructed ACL has a high success rate. Studies show that cases in which the ACL retears are generally caused by a traumatic impact. Statistically, it does not appear to matter if the patient uses a brace after recovery. A sufficiently traumatic impact to retear the ACL is unlikely to be mitigated by the use of a brace.
References - Dawn Hastreiter, ACL Reconstruction, University of Washington, UWMC Roosevelt Clinic, Musculoskeletal Radiology.
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