Reconstructive surgery is a common treatment option for anterior cruciate ligament (ACL) tears. The surgery aims to prevent the shinbone (tibia) from moving too far forward, and restore the normal functioning of the knee in order to prevent further damage to its surrounding cartilage.
During ACL surgery, the doctor will remove what remains of the torn ligament and install a replacement in the same location. In the last ten years, the techniques used in ACL surgery have changed significantly, and improvements have been made that now allow patients to recover from the surgery much faster than before. A knee arthroscopy, for example, is a new technique which has evolved significantly in recent years as a treatment option for a torn ACL.
Types of Surgery
The three main types of ACL surgery are known as single-bundle, double-bundle and selective bundle reconstructive surgery.
- Single-bundle ACL reconstruction: Doctor usually choose this type of surgery to operate on a torn ligament that does not require rotation, or when the patient has only limited control of joint movement, such as after repeat surgery following previously unsuccessful surgery.
- Double-bundle ACL reconstruction: This method is the new standard for ACL reconstructive surgery. It is supported by a wealth of research which demonstrates that double-bundle ACL surgery can restore greater strength to a torn ACL that requires rotation, when compared with single-bundle surgery (Am J Sports Med 2010;38(1):25 and Am J Sports Med 2008;36(2):290).
- Selective bundle reconstruction: This type of surgery is used in cases where many parts of the ACL have suffered injury. With selective bundle reconstruction, it is not necessary for the doctor to remove the whole of the ACL, but only the injured parts of it. This method uses natural fiber replacements, which helps to stabilize the position of the shinbone and the functioning of surrounding muscles, so that the patient can regain control of the bones of the leg (Knee Surg Sports Traumatol Arthrosc 2010; 18:47–51).
Risks of Surgery
- Risks associated with use of an anesthetic.
- Numbness or weakness in the legs due to long-term posture changes.
- Bleeding during and after surgery.
- Damage to nearby organs during surgery, such as nerve endings, blood vessels and kneecaps.
- Infection of bones or joints, which may occur immediately or shortly after surgery.
Preparations Before Surgery
- Do not eat or drink for around 6 - 8 hours before surgery.
- Do not take aspirin or other blood-thinning medications for at least one week before surgery. Patients should also inform their doctor if they are using any other medication.
- Undergoing physiotherapy before surgery helps the knee to return to its original functioning as quickly as possible. Patients who receive ACL surgery while the knee is still in pain or still swollen after injury usually have problems rehabilitating the knee following surgery.
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