What Type of Surgery Is Required for an ACL Tear?
The anterior cruciate ligament (ACL) is one of the four major ligaments of the knee. Twisting or pivoting movements are what cause the ACL to strain or tear.
Ligaments are strong, dense structures made of connective tissues that help stabilize a joint. The ACL connects the femur to the tibia and helps provide stability to the knee and minimize stress across the knee joint.
Most Common Signs of an ACL Tear
ACL tears occur in athletes participating in cutting and pivoting sports such as basketball, football, soccer, and skiing. The athlete typically feels a “pop” or a tearing sensation and experiences swelling within six hours of the injury.
Other symptoms of an ACL knee injury include a feeling of instability, swelling, pain, or a loss of range of motion. The RICE method (rest, ice, compression, and elevation) can help improve pain and swelling immediately after the injury. Patients may need to use crutches and/or reduce the amount of weight put on the knee before surgery.
How Can You Treat an ACL Tear?
ACL strains can sometimes be treated with physical therapy and muscle strengthening, however, most complete tears require surgery in active patients . Modern ACL surgery involves completely removing the torn ligament and reconstructing the torn ACL using a minimally invasive arthroscopic technique. The most common grafts used to reconstruct a torn ACL are the patella tendon, hamstring tendons, or cadaver tissue (allograft). Each graft offers specific advantages and disadvantages, so it is important to understand the differences.
Contact Dr. Fuchs, a knee specialist in Kirkland, Washington, at (425) 823-4000 to find out the best treatment for you.
“Today we are going to review the ACL reconstruction technique. This technique is designed to provide a patient with a new anterior cruciate ligament.
This patient has a left ACL tear and it is being probed and you can see that the ACL is completely torn from the femoral origin. There are only a few fibers left in continuity. The first step in an ACL reconstruction is removing the torn ACL. This is performed using an arthroscopic shaver, and the torn ACL is carefully debrided identifying the tibial insertion.
The next step is debriding the femoral notch by using an arthroscopic burr, opening up the entry site for the placement of a new ACL. You can see here the arthroscopic shaver is used to clean out any residual debris. A nice opening has been made for the ACL.
The next step is identifying the insertion on the tibia with a guide pen, and then placing a drill over the guide pen, and drilling up through the tibia creating a tibial tunnel.
This is carefully evaluated, and the next step is placement of a femoral tunnel. In this procedure a 10mm tunnel is made in the femur, leaving just a small cortical rim posteriorly along the back of the femur. Here you can see it is being probed. There is only approximately 1mm of bone remaining. We carefully look up the tunnel to ensure there is surrounding bone for the placement of the new ACL.
During this procedure, a patellar tendon autograft is being used, which has been harvested from the front of the knee. Other graft options include hamstring and allograft tissue. During this case, the patellar tendon autograft is being brought up through the tibial tunnel into the femoral tunnel using a pull suture, and then it is probed for stability.
Next, an interference screw is placed over a guide-wire in the distal femur, securing the new ACL graft in the femur. A tibial screw is placed for tibial fixation, and then the graft is probed and checked for final stability. This concludes our ACL reconstruction technique.”