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By Mayo Clinic staffIn most instances, ACL reconstruction is an outpatient procedure using general anesthesia and arthroscopy (ahr-THROS-kuh-pee). With arthroscopy, your surgeon can see and operate on your knee through small incisions, one to hold a thin, tube-like optical instrument (arthroscope) attached to a video camera, and the others to allow surgical instruments into the joint space.
During the procedure
For the reconstruction itself, you will:
- Undress, put on a hospital gown and remove your jewelry and glasses, if you wear them
- Have an intravenous (IV) line put in, usually into a vein in your arm, so that your medical team can give you medication you may need during surgery
- Possibly be given a sedative
- Meet with your surgeon to go over any last-minute concerns
- Meet with an anesthesiologist or nurse anesthetist to go over the type of anesthesia you'll be given and get answers to questions you have
- Be transported on a wheeled bed (gurney) to the operating room
- Be given anesthetics to make you unconscious (general) or to numb the area (local) for the duration of the procedure
Your surgeon will then make one or two small incisions and insert the arthroscope and instruments. Inside your knee, the camera records and simultaneously displays images on a monitor next to the operating table. These images guide your surgeon in repairing your damaged ACL. Steps in the repair may include:
- Removing the damaged ligament
- Removing a piece of tendon from another part of your leg (autograft) or from a cadaver (allograft)
- Drilling tunnels in your thighbone and shinbone to anchor the graft
- Replacing the damaged ligament with the graft, connecting it to your thighbone and shinbone, usually with screws
- Closing the wound
If your own tendons don't provide the best replacement for the injured ligament, your doctor may recommend using a tendon from a cadaver (allograft). The cadavers used for allografts have been carefully screened and tested for diseases.
After the procedure
After your surgery, you'll be taken to a recovery room. During this time, a nurse will monitor your blood pressure, pulse and breathing. If you've had outpatient surgery, you'll be released when your condition is stable.
Expect to:
- Possibly wear a knee brace for one or more weeks
- Possibly need crutches for up to six weeks
- Have some pain
- Be given written instructions about post-surgical care, including caring for the incision and dressing, recognizing signs of infection
- Be given a prescription for pain medication
- Be given a recommendation for physical therapy
- Have restrictions on your activity, usually for several months
- Be given a follow-up appointment to meet with your doctor shortly after surgery
- Clark JC, et al. Primary ACL reconstruction using allograft tissue. Clinical Sports Medicine. 2009;28:223.
- Anterior cruciate ligament injuries. In: Canale ST: Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa.: Mosby Elsevier; 2007:2496.
- Muscle and tendon injuries. In: Brunicardi FC, et al. Schwartz's Principles of Surgery. 8th ed. Columbus, Ohio.: McGraw-Hill; 2005. http://www.accessmedicine.com/content.aspx?aID=820647. Accessed Sept. 30, 2009.
- Fu F, et al. Current trends in anterior cruciate ligament reconstruction part 1: Biology and biomechanics of reconstruction. American Journal of Sports Medicine. 1999;27:821.
- ACL injury: Does it require surgery? American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00297. Accessed Oct. 1, 2009.
- Friedberg RP. Anterior cruciate ligament injury. http://www.uptodate.com/home/index.html. Accessed Oct.1, 2009.
- Spindler KP, et al. Anterior cruciate ligament tear. New England Journal of Medicine. 2008;359:2135.
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