Anterior Cruciate Ligament Reconstruction (ACL Reconstruction)

The anterior cruciate ligament (ACL) is a 3-4cm fibrous ligament that connects thetibia (shin bone) and the femur (thigh bone). This cruciate ligament helps in stabilising the knee joint when performingdifferent actions, especially during side stepping, pivotingand landing from a jump. The ACL is commonly injured while playing, running, or skiing.When this ligament tears, unfortunately it doesn't heal and often leads to instability in the knee joint. When ACL injury occurs, patients hear or feel asnap, or crack accompanied by pain. Swellingoccurs within the hour, but is amelioratedby ice or compression. Frequently pain is felt on theouter part of the knee joint as the joint dislocates.

ACL reconstruction is surgery to reconstruct the ligament in the center of the knee.ACL reconstruction is a commonly performed surgical procedure and due to recent advances in arthroscopic surgery, it can now be performed with minimal incisions and less complication.The goal of the treatment is tominimize the swelling, promote wound healing, regain full range of motion, and return the patient to their desired level of activity. Treatment may be without surgery (conservativetreatment) or with surgery (surgical treatment).The reconstruction surgery is advised only when conservative treatment fails or will not be useful in severe cases of injury.

Patients who are young adults, active at playing sports, unwilling to lower their level of activity, areat risk of causing further damage to their kneeareadvised to undergo surgical reconstruction.Different technique of surgery includes arthroscopic vs open surgery, intra vs extra-articular reconstruction, femoral tunnel placement, number of graft strands, single vs double bundle and fixation methods. In the most common ACL reconstruction surgery, tunnels are drilled into the tibia bone and the femur bone to place the graft in the same original position as the torn ACL. A needle is passed through thesebones tunnels and then out through the skin of the thigh. The graft is fixed in place using screws, posts, or staples.

Surgical Complications

• Infection The incidence of post-surgical infection after arthroscopic ACL reconstruction is very low. Measures should be taken to minimise bacterial infection from allograft tissue due to improper procurement and sterilization techniques.
• Instability Even after surgery, there are chances of recurrent instability due to rupture of the reconstructed ligament or poor surgical technique
• Viral transmission There are very rare chances of obtaining a bone allograft associated with risk of viral transmission, including HIV and hepatitis C, despite careful screening and processing.
• Bleeding, numbness There may be bleeding from acute injury to the popliteal artery, and weakness or paralysis of the leg or foot. There may be numbness of the outer part of the leg next to the incision, which may either be temporary or permanent.
• Blood clot in the veins of the calf or thigh may break off in the bloodstream and travel to the lungs, causing pulmonary embolism or to the brain, causing stroke. This is a potentially life-threatening complication.
• Kneecap pain Post-operative knee pain (anterior side) is usually common after patellar tendon autograft ACL reconstruction surgery

The end result for the patient post-surgery depends largely upon a satisfactory rehabilitation. Physical therapy is an integral part of the treatment and is recommended to start as early as possible. The rehabilitation will be supervised by a physiotherapist and they will suggest to getinvolved in activities such as riding bikes, swimming, and muscle strengthening exercises. The normal activities can resume within 3-6 months of surgery depending on various factors.