Sewing extremities of the torn ligament (primary repair) is useless. Surgery involves replacing the ACL by a graft. Then there is no "hurry" to do surgery when the rupture of the ACL is the only injury to the knee.

Four to eight weeks are necessary before surgery: it is essential to wait for the knee to settle down, for the swelling to subside and to have full mobility before surgery.

When the lateral collateral ligament is injured, surgery must be done quickly to repair it first. If the full extension is impossible because of a meniscus lesion, arthroscopy will be necessary rapidly to excise or suture the torn meniscus fragment. The reconstruction of the ACL can be done in the same time or later.

I THE OPERATION

The operation usually takes about 50- 60 minutes; it is carried out arthroscopically except the first phase: harvest of the graft. Then after assessment of the lesions, the remnants of the broken ligament are partly taken away: one of the two bundles of the ACL is frequently intact. Tibia and femur are prepared for making tunnels (with jigs) through which the graft will be passed. The graft is then inserted with appropriate tension and fixed with screws, pins or endobuttons. (more and photos)

II AFTER SURGERY
After surgery, relief of pain by medicines, icing to decrease swelling are started and the patient does simple exercises for strengthening the muscle of the thigh (quadriceps). On the day after, passive flexion is started by the patient. He can walk with crutches and take weight through the operated knee but he must keep his quadriceps contracted +++. Note that I use no bracing after this type of surgery.

Patient commitment and involvement are essential for a good functional result +++.

The inpatient stay is usually between 3 and 5 days. For the first three weeks, the patient will simply continue the exercises started in the hospital (strengthening of the quadriceps, passive flexion and walking with the leg kept straight by the quadriceps contraction). The rehabilitation with a physiotherapist usually only starts after the first three weeks. MORE

You must keep me informed as you go along of every problem you may have (lack of extension, stiffness, swelling, pain ...); it is important to prevent, diagnose and treat possible complications +++. More than that, it will help you going well if I answer to your questions as you go along. I recommend you not to wait for the next appointment if you are worried about something (pain, swelling or anything else).

III 8 weeks after surgery

The aim is to return to daily living with no pain, no limping, no swelling and good motion (0 -130°). I then recommend to stop rehabilitation, and to go swimming (but no breaststroke). Cycling can be started on the fourth month, jogging on the fifth month. All these activities must be done progressively and without pain.

IV Five months later
We meet again five months after your operation for a clinical and radiological examination. You will then finish the process of rehabilitation during the sixth month to reinforce your muscles and especially do some proprioceptive exercises to be able to practice your sports with pivoting and twisting in the seventh or eighth month.

V Risks and complications:
This operation is not free from complications even if it is a fairly routine and safe operation:

• General anaesthetic risks are always present as anybody undergoes general or regional anaesthesia.
• Specific risks:
  • Infection
  • Damage to vessels or nerves.
  • Reflex sympathetic dystrophy
    • are very rare occurrences.
  • Deep venous thrombosis (blood clots in a vein of the leg)
  • Numbness around the incision: there is usually a patch of numbness or sensory disturbance in front of the knee joint, secondary to bruising or damage to the skin nerves that supply the area. This may be permanent.
  • Stiffness
  • Rupture of the graft: the graft can fail early by rupture of its fixation or lately due to a further injury.
  • Ongoing instability and pain

  I once again insist on how important it is, to keep me informed as you go along of any problem you meet +++.
  

Docteur Jean Etienne Perraudin; Last updated 1 sept 2012.