Knee surgery, anterior cruciate ligament
Anumber of methods can be used to reconstruct ananterior cruciate ligament (ACL). The most common method is to use a tendon from elsewhere in your body to replace the ACL.
You'll either have a general anaesthetic ,which means you'll be totally unconscious during the procedure, ora spinal anaesthetic , where anaesthetic is injected into your spine so that you're conscious, butunable tofeel pain.
Your anaesthetist willdiscuss the procedure with you andcan recommend which type of anaesthetic to use. The operationwill take one to one-and-a-half hours and will usuallyrequire an overnight stay in hospital.
After you've been anaesthetised, thesurgeon will carefully examine theinside ofyour knee, usually witha medical instrumentcalled an arthroscope (see below).
Your surgeonwill check that your ACL is torn and look for damage to other parts of your knee. Any other damage found might be repaired during the surgery to your ACL or after your operation.
After confirming that your ACL is torn, your surgeon will remove thegraft tissue, ready for relocation.
Anumber ofdifferent tissues can be used to replace your ACL.
Tissue taken from your own body is known as an autograft. Tissue taken from a donor is known as an allograft. A donor is someone who has given permission for parts of their body to be used after they die by someone who needs them.
Before your operation, your surgeon will discuss the best option with you. Tissues that could be usedto replace your ACL are listed below.
Themost commonly used autograft tissues are the patellar tendon and the hamstring tendons. Both have been found to be equally successful.
Allograft tissue may be the preferred option for people who aren't going to be playing high-demand sports, such as basketball or football, as these tendons are slightly weaker.
Synthetic (man-made) tissues are currently used in certain situations, such as revision surgery and multi-ligament injuries.
The graft tissue will be removed and cut to the correct size. It will then be positioned in the knee and fixed to the femur (thigh bone) and tibia (shin bone). This is usually carried out using a technique known as a Arthroscopy .
An arthroscopy is a type of keyhole surgery. It uses a medical instrument called anarthroscope, which is a thin, flexible tube with bundles of fibre-optic cables inside that act as both a light source and camera.
Your surgeon will make a small incision on the front of your knee and insert the arthroscope. The arthroscope will illuminate your knee joint and relay images of your knee to a television monitor. This will allow the surgeon to see the inside of your knee clearly.
Additional small incisions willbe made in your knee, so that other medical instrumentscan be inserted. The surgeon willuse these instruments to remove the torn ligament and reconstruct your ACL.
Your surgeon will make a tunnel in your bone to pass the new tissue through. The graft tissue will be positioned in the same place as the old ACL, and held in place with screws or staples that will remain in your knee permanently.
After the graft tissue has been secured, your surgeon will test that there's enough tension in it (that it's strong enough to hold your knee together).
They'll also check that your knee has the full range of motion and that the graft keeps your knee stable when it's bent or moved.
When the surgeon is satisfied that everything is working properly, they'll use stitches to close the incisions and apply dressings.
After the procedure, you'll be moved to a hospital ward to begin your recovery.
Read about how an anterior cruciate ligament (ACL) injury is caused, and the considerations when deciding whether to have reconstructive surgery.
Read about the things you need to consider when deciding whether to have knee surgery, including your age, lifestyle, occupation and whether you play sports.
Information about preparing for knee surgery, including having physiotherapy to regain strength and mobility in your knee, and attending a pre-admission clinic.
Read about how anterior cruciate ligament (ACL) surgery is carried out, either using tissue taken from your own body (autograft) or tissue taken from a donor (allograft).
Read about the possible risks of anterior cruciate ligament (ACL) surgery, including pain and swelling in the replacement ligament, infection or a blood clot.
Find out about recovering from anterior cruciate ligament (ACL) knee surgery, including advice about physiotherapy, gentle exercises and using painkillers.