Overview:
The anterior cruciate ligament (ACL)
is the major stabilizing ligament of the knee. The ACL is located in the center
of the knee joint and runs from the femur (thigh bone) to the tibia (shin
bone), through the center of the knee. In this position, it functions to
prevent a buckling type of instability of the knee.
ACL reconstruction is surgery to replace the ligament in the center of your knee with a new ligament. The anterior cruciate ligament (ACL) keeps your shin bone (tibia) in place. A tear of this ligament can cause your knee to give way during physical activity.
After a traumatic knee injury, people will find themselves
in the local emergency room getting X-rays, MRI's, Casts, and other diagnostic testing
to determine the damage. Initial treatment after injury is ice,
anti-inflammatory medication, and some form of physical therapy to restore
range of motion in the damaged knee. ACL tears occur from a sudden direction
change, landing incorrectly, traumatic collision, and over rotation. Patients
typically report a popping sensation (and sound) deep inside the knee followed
by instability that they've never had before. In some televised sporting events
an athlete will damage this ligament and continue to play, but once they put
weight on the injured leg they collapse. The anterior cruciate ligament is the
major stabilizing ligament in the knee (especially rotational stability) and
prevents the femur from sliding backwards on the tibia. It's located in the
center of the knee joint and go's from the thigh bone (femur) to the shine bone
(tibia). This ligament essentially prevents the knee from buckling backwards.
Procedure
There are several options available when treating an ACL injury. The most common treatment is to replace your native ACL with a new ligament. Typically, the new ligament material (graft) can be taken from one of the patient's own tendons (autograft), or the graft can be taken from a tendon in the knee of a tissue donor (allograft). You and your doctor will decide which option is best for your particular situation.ACL Reconstruction is usually performed as an outpatient procedure and rarely requires an overnight stay in the hospital. The entire procedure requires approximately 1-2 hours to complete and is typically performed under general anesthesia, spinal or epidural.
ACL Reconstruction is most often performed arthroscopically. Arthroscopy is a surgical technique that uses long tube-like scopes that are inserted into the body through very small incisions. These scopes display the inside of your knee joint on a monitor, allowing the surgeon to precisely manipulate the surgical instruments. The benefits of arthroscopic surgery are a shorter recovery period, smaller incisions (one-quarter to one-half inch in length), minimal scarring, and less potential for infection.
The ACL Reconstruction procedure creates tunnels in the thigh bone (femur) and the shin bone (tibia) to make a path for the new graft (tendon). One of the most common graft used is the semi-tendonosis/gracilis graft. This graft is taken from a portion of the muscles in the thigh. The graft is passed through specially designed instruments into the tunnels and fixed inside the tunnels. The new graft is fixed inside the tunnels with screws, buttons, pins, or similar devices. Some of those devices are made out of materials that resorb or dissolve with time and are replaced with bone by the body. The graft crosses the joint in the position as the original ACL after it is fixed with these devices. The small incisions are then closed and a knee compression bandage is applied. Some surgeons prefer to use a long leg brace postoperatively.
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