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).

• 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.