Arthroscopy is a minimally invasive surgery technique. A few small incisions are made around the joint to allow a camera and various instruments to pass through. These instruments tools allow for the anatomic structures to be visualized and the ACL tear confirmed. Tunnels in the tibia and shin bone are made through which a new graft can be placed and secured in position, making a new ACL.
Why ACL reconstruction
A knee arthroscopy is a minimally invasive procedure that involves creating 2 small incisions (roughly 0.5 inch each) around the knee joint. These small portals allow a camera to enter the joint for visualization of anatomic structures, as well as tools to repair any injured structures. There are several graft options that can be used to reconstruct the knee. The type of graft used is tailored to each patient and depends on age, sport, and activity level. Most commonly, a portion of the patellar tendon attached to bone on each end is used. Bone tunnels are created in the femur and tibia that will accommodate the bone on each side of the tendon graft and is secured with metal screws that compress the bone in the tunnels. This allows for bone-to-bone healing. The knee is examined to ensure restoration of the stability to the knee. The incisions are closed and dressings applied. An ACE wrap and brace will be placed on the patient prior to waking up from anesthesia.
- This surgery is most often performed under general anesthesia with a nerve block, but can be performed with a spinal anesthetic, nerve block, and sedation.
- This surgery is usually outpatient, which means the patient will be able to go home the same day.
- Surgery typically lasts 1.5-2 hours.
- The incisions will be closed with absorbable suture, and dressings will be applied that can usually be removed 2-3 days after surgery.
- Patient will be fit for a brace at a preop appointment, which will need to be brought to surgery.
- The brace will be placed on the patient prior to waking up from anesthesia.
- The brace will need to be worn locked in full extension when walking and at night, but should be unlocked at least three times a day and may also be removed for hygiene. The brace is usually discontinued once the patient regains enough quad strength to keep the knee full straight when the leg is raised off the bed (i.e. straight leg raise).
Why ACL Reconstruction for ACL Tear
- Reduce pain
- Eliminate sensation of instability
- Reduce chance of further damage to other structures in the knee such as cartilage and menisci
- Return to activity safely with strength and confidence
- Patients who have recovered full knee range of motion
- Patients who have persistent pain and instability
- Active patients who want to return to sport or activities involving rotational movements
It can take up to a year for patients to return to sport at a level similar to their pre-injury state following an ACL reconstruction. The patient will wear a knee brace when ambulating and at night until their quads recover enough strength to perform a straight leg raise (usually about 1 month). The brace can be unlocked almost immediately after surgery when performing knee range of motion exercises. Physical therapy (PT) will start roughly 2 weeks after surgery. Physical therapists follow a protocol outlined by Dr. Faulkner to regain range of motion and strength. Physical therapy and home exercises are a critical part to a patient’s outcomes and quality of life after surgery. Patients typically transition to a home exercise program several months after surgery, then return to formal PT around 7-9 months postop for functional training. These last physical therapy sessions are geared toward getting patients back to their pre-injury functional performance. Patients can expect to continue to improve with range of motion and strength up to 1 year after surgery, with most of the gains occurring within the first few months after surgery. Patients should plan on being seen in clinic about every 6 weeks for the first few months and then every couple of months for the first year after surgery for close monitoring and to ensure any questions are answered.
The level of care I received from Dr. Faulkner was stupendous. Even with a 2nd ACL reconstruction…Thank you for an incredible outcome and getting me back to doing what I love!
Cyrus Pearo - Cyclist
Hey Dr. Faulkner! 16 months post ACL surgery and I am an Ironman! Knee felt great the entire day. Thanks for fixing me!
Eric Nielson - IRONMAN
After injuring my ACL and meniscus for the third time, I went to see Dr. Faulkner who additionally diagnosed laxity in the Anterolateral Ligament (ALL) of my left knee. Dr Faulkner is one of the few surgeons in the region that can do ALL repairs. Immediately after recovering from the surgery I could tell that there was more stability in my left knee than there had been in a long time. Even though it was a very complex surgery I recovered with strength and full range of motion very quickly. I am back to running daily without any pain or swelling and I plan to ski this season.
Revision ACL reconstruction
It's been a long, humbling journey but I feel my legs are in the best shape they've been in years. I want to thank you for the phenomenal work you performed on my knee, you can't tell I had surgery by looking at it and I bounced back quicker then I expected. You're a master of your craft. Definitely a team effort with you, Cara and my physical therapists and I couldn't have done it without you guys.
Yes, as long as the brace is locked in full extension. Physical therapists will work with you to help you regain your range of motion and strength.
Sometimes weightbearing will be restricted if a meniscal repair was also performed.
You should not drive for 6 weeks if the operative leg was your right leg. If the operative leg was your left leg, we recommend not driving for at least a couple of days as long as you are no longer taking any narcotics.
A prescription for a narcotic will be given to you at your preoperative appointment. Dr. Faulkner or his PA, Cara, will review instructions for this medication and what other over the counter medications can be taken to control pain. Risks and side effects will also be discussed.
You will typically start physical therapy 2 weeks after surgery.
TED hose are worn to help prevent blood clots in the legs. These should be worn for several hours a day for two weeks after surgery.
You should take an Aspirin 325 mg to prevent the risk of blood clots for 2 weeks after surgery. If you have a personal history of blood clots or other risk factors, Dr. Faulkner or his PA, Cara, may prescribe a stronger blood thinner.
You may shower 48 hours after surgery. The dressings placed over the incision may be removed at this time; however, the steri-strips are to be left in place. You may get the incisions wet, but should not soak them in water until the wounds are completely healed.