ACL Reconstruction

Anterior Cruciate Ligament Tears

The anterior cruciate ligament (ACL) is one of the major stabilizing ligaments in the knee. It is a strong rope-like structure located in the center of the knee, running from the femur to the tibia. When this ligament tears, unfortunately, it does not heal on its own, and often leads to the feeling of instability in the knee.

Causes of an ACL Injury

An ACL injury most commonly occurs during sports that involve twisting or overextending of your knee. An ACL can be injured in several ways:

Sudden directional change
Slowing down while running
Landing incorrectly from a jump
Direct blow to the side of your knee, such as during a football tackle

Symptoms of ACL Injury

When you injure your ACL, you might hear a loud "pop" sound and may feel the knee buckle. Within a few hours after an ACL injury, your knee may swell due to bleeding from vessels within the torn ligament. You may notice that the knee feels unstable or seems to give way, especially when trying to change direction on the knee.

Diagnosis of an ACL Injury

An ACL injury can be diagnosed with a thorough physical examination of the knee and diagnostic tests such as X-rays, MRI scans and arthroscopy. X-rays may be needed to rule out any fractures. In addition, your doctor will often perform the Lachman’s test to check if the ACL is intact. During a Lachman test, the knee with a torn ACL may show increased forward movement of the tibia, and a soft or mushy endpoint compared to a healthy knee.

Pivot shift test is another test to assess ACL tears. During this test, if the ACL is torn, the tibia will move forward when the knee is completely straight and as the knee bends past 30° the tibia shifts back into the correct place in relation to the femur.

What is an ACL Reconstruction?

ACL reconstruction is a commonly performed surgical procedure. With recent advances in arthroscopic surgery, it is now be performed with small incisions, has low complication rates, and patients are usually discharged home the same day.

The advancements in arthroscopic surgery make it easy for surgeons to view and work on the knee structures through small incisions. The ACL reconstruction is performed using either your own tissue (autograft) or cadaver tissue (allograft). You and your surgeon will have a lengthy discussion pre-operatively regarding the pros and cons of each and you will be able to choose which graft you prefer to use for ACL reconstruction.

If you have a meniscus tear or cartilage injury in your knee in addition to the ACL tear surgery on these structures will be performed by the surgeon at the same time as the ACL reconstruction.