ACL Reconstruction and Meniscus Repair Surgery

What is ACL Reconstruction?

The ACL, or anterior cruciate ligament, is a structure within the knee that helps to control movement and rotation of the knee joint. It is one of the most common knee ligaments that can be injured and may be torn during a sudden, twisting movement of the knee.

In ACL reconstruction, the torn ligament is removed and replaced with a piece of tendon from another part of your knee or from a deceased donor. This surgery is an outpatient procedure that is performed through small incisions around your knee joint. Many orthopaedic surgeons prefer to use arthroscopic surgery rather than open surgery for ACL injuries because:

  • It is easy to see and to work on the knee structures.
  • Smaller incisions are required.
  • It has fewer risks than open surgery.

Why is ACL Reconstruction done?

The goal before surgery is to reduce pain and swelling, to restore your knee’s full range of motion, and strengthen muscles. Not all ACL tear require surgery. Your physician will decide whether only rehabilitation or surgery plus rehabilitation is right for you.

You may choose to have surgery if you:

  • Have a completely torn ACL and your knee is very unstable.
  • Have gone through rehabilitation and your knee is still unstable.
  • Are very active in sports or have a job requiring knee strength and stability (such as construction work), and you want your knee to be just as strong and stable as it was before your injury.
  • Have chronic ACL deficiency, that is when your knee is unstable and affecting the quality of your life.

How is ACL reconstruction performed?

Before your surgery, you will have to undergo several weeks of physical therapy. ACL reconstruction is performed with general anaesthesia and it is an outpatient procedure, so you will be able to go home on the same day.

Step 1 – ACL reconstruction is usually done through small incisions. One to hold a thin, tube-like video camera (arthroscope) and others are to allow surgical instruments access to the joint space. 

Step 2 – Your surgeon will remove your damaged ligament, and replace it with a segment of tendon, which is called a graft. This can be an autograft (using a tendon from your own knee) or an allograft (using a donor tendon).

Step 3 – Your surgeon will drill sockets or tunnels into your thighbone and shinbone to position the graft accurately, which is then secured to your bones with screws and other fixation devices. The graft will serve as a scaffolding on which new ligament tissue can grow. 

What happens after ACL reconstruction?
  • Once you recover from the anaesthesia, you can go home on same day. But before you are discharged, you will need to practice walking with crutches, and your surgeon may ask you to wear a knee brace or splint to help you protect the graft.
  • Your doctor will give you specific instructions on how to control swelling and pain after the surgery. It is important to keep your leg elevated, apply ice to your knee and rest as much as possible.
  • After surgery, physical therapy will help you regain your range of motion and strengthen the muscle which supports the joint and improves the flexibility. A physical therapist will teach you how to do exercises that you will perform under his supervision or continue the same at home.

What are the risks of ACL reconstruction?

The risks associated with ACL reconstruction will include the following:

  • Knee pain or stiffness
  • bleeding and infection at the surgical site
  • Poor healing if the graft is rejected by your immune system
  • loss of range of motion
  • Graft failure after returning to sport
  • disease transmission if the graft comes from a deceased donor

What is the outcome and recovery of ACL reconstruction?

  • Successful ACL reconstruction along with focused rehabilitation can restore stability and function to your knee.
  • Within the first few weeks after surgery, you should strive to regain a range of motion equal to your opposite knee.
  • In general, recovery takes about nine months. It can take 8 to 12 months approximately for athletes to return to their sports.

What is the role of a meniscus in a knee joint?

The meniscus is a crescent-shaped disc of cartilage which is between your femur (thighbone) and tibia (shinbone). There are two menisci in each knee joint. The meniscus is like a shock absorber that helps to stabilize the knee by balancing your weight across the knee. It also provides protection of healthy cartilage in the knee joint.

What is a meniscus tear in a knee joint?

Each of your knees has a two C-shaped pieces of cartilage that act like a cushion between your shinbone and thighbone (menisci). A meniscus tear causes pain, swelling and stiffness. You also might feel an obstruction to knee motion and have trouble extending your knee fully. A meniscus tear can lead to an inability to move your knee normally or persistent knee pain. You may be more likely to develop osteoarthritis in the injured knee.

What are the causes of a meniscus tear?

  • Any activity causing you to forcefully twist or rotate your knee, especially when putting your full weight on it, or by lifting something heavy can lead to a meniscus tear.
  • The meniscus weakens with age and meniscus tears have become more common in people over the age of 30. If you have osteoarthritis, you are at a higher risk of injuring your knee or tearing your meniscus. Osteoarthritis is a common joint disorder involving pain and stiffness in your joints which is caused by aging and wear and tear. 
  • When an older person experiences a meniscus tear, it is related to degeneration. This is when the cartilage in the knee becomes weaker and thinner and as a result, it is more prone to tear.

What are the Symptoms of meniscus tear?

When a meniscus tear occurs, you may hear a popping sound around your knee joint and you may experience the following:

  • Pain when the area is touched
  • swelling or stiffness
  • difficulty moving your knee in a full range of motion
  • Your knee will be locking or catching.
  • your knee will be unstable

What is the treatment for a meniscus tear?

If the tear is small and is on the outer edge of the meniscus, patient may not require a surgical repair. As long as the symptoms like excessive pain, swelling, inability of knee movements, cracking sound does not persist then your knee is stable and nonsurgical treatment can be advisable. Initially, you should treat the knee injury with conservative techniques which include rest, ice, compression, and elevation, or the RICE method:

  • Rest your knee: Use crutches to avoid any weight on the joint. Avoid any activities that can worsen your knee pain.
  • Ice your knee every three to four hours.
  • Compress the knee in an elastic bandage to reduce inflammation.
  • Elevate your knee to reduce swelling.

If symptoms persist with nonsurgical treatment, then you should go for Meniscus Repair surgery.

What are the Types of Meniscus Repair Surgery?

Meniscus Repair Surgery is a procedure to repair torn knee cartilage. There are surgical and non-surgical treatments for Meniscus repair depending upon the case. Depending upon the intensity of the tear, which can be mild (grade1, 2) or severe (grade 3), your surgeon will choose the following procedure based on your condition:

Arthroscopic repair – In this procedure, the surgeon makes small cuts in knee and then inserts an arthroscope to have a clear view of the tear. Then a small device is placed that seem like a dart on the tear to sew it up and then the body will absorb these over time.

Arthroscopic partial meniscectomy – In this procedure the surgeon will remove a piece of the torn meniscus so the patient’s knee can function normally.

Arthroscopic total meniscectomy – In this procedure, the surgeon will remove the whole meniscus.

How is the Meniscus Tear Surgery performed?

This surgical procedure usually last for an hour.

  • Partial Meniscectomy – Accordingly surgical instruments are used to trim or repair the meniscus.
  • Mensicus Repair – In this procedure, the broken cartilage tissue is removed.

Step 1 – Our specialists perform meniscus tear surgery arthroscopically, by making small cuts in the knee. The surgeon inserts an arthroscope through a small incision (portal) to see the kind of repair. This provides a transparent view of  the knee.

Step 2 – When the surgeon locates the problem in your knee, he may insert small tools into the incisions to repair or trim the damaged meniscus. However, some cartilage tears may be repaired by sewing (stitching) the torn parts .

What is the outcome and recovery for Meniscus Tear Surgery?

In some cases the recovery from meniscus surgery is measured by days to weeks, and in cases of a meniscus repair it can take few months to recover fully.

  • The recovery totally depends on whether you had a meniscus repair (sutures) or if simply had the torn pieces removed (partial menisectomy). The Cartilage in a knee joint does not have a significant blood supply, which can affect its ability to heal. However, there are some areas of the meniscus, such as the outer portions, which have more blood vessels and are more likely to heal.
  • You should use an ice pack on your knee and a dressing and keep your leg elevated for a day or two. The ice will help to reduce swelling and reduce your pain.
  • You can participate in physical therapy within a few days after surgery. If your procedure involves a meniscal repair, then the recovery and rehabilitation time is about six weeks. You will wear a knee brace or crutches during this time. Rehabilitation exercises will help to regain range of motion and strengthen the muscles that support the joint.

Frequently asked Questions:

How successful is ACL reconstruction?

ACL reconstruction has been a successful operation, with satisfactory outcomes in 75% to 97% of patients (4, 5). However, with the number of primary procedures being performed increasing each year, the absolute number of graft failures after ACL repair is also rising.

How many years does an ACL repair last?

Reconstruction patients even 20 years later revealed excellent performance, with over 85% still active. However, over 40% revealed some degree of osteoarthritis.

How long do I have to wear my knee brace after ACL surgery?

You must wear the hinged-knee brace for the first 6 weeks. This brace protects the meniscus repair because it prevents you from bending the knee more than 90 degree.

What is the strongest ACL graft?

Patella Tendon Autograft – It has a stronger fixation because of the bone plugs that can incorporate into the femoral and tibial tunnels by 6-8 weeks after surgery.

How is a meniscus tear diagnosed?

A meniscus injury can be diagnosed by an X-ray and it can help the doctor rule out other causes of knee pain, such as a fracture or arthritis. To properly visualize the meniscus and adjacent cartilage, an MRI scan may be indicated for some patients.

How long do you have to wear a knee brace after meniscus surgery?

You must wear the hinged – knee brace for the first 6 weeks. This brace protects the meniscus repair because it can prevent you from bending the knee past 90 degrees.

Is a torn meniscus a permanent injury?

Patients with a torn meniscus often complain of locking, catching, popping, or sticking in the knee. Left unattended, a meniscus injury can linger for years, causing ongoing pain and limited mobility. If a meniscus tear is not repaired, you risk further injury and permanent damage to your knee.

What happens if you do not repair a meniscus tear?

If untreated, part of the meniscus may become loose and slip into the joint. You may need surgery to restore the knee function. Untreated meniscus tears can increase in size and may lead to complications, such as arthritis.

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