ACL Reconstruction Surgery Procedure

Introduction

ACL (Anterior Cruciate Ligament) reconstruction is a surgical procedure performed to replace a torn ACL with a new ligament graft. The goal of the surgery is to restore knee stability, improve movement, reduce pain, and allow the patient to return to normal activities or sports. The procedure is commonly performed using arthroscopy, a minimally invasive technique that ensures faster recovery and less tissue damage.

Below is a detailed step-by-step explanation of the ACL reconstruction surgery procedure.

ACL Reconstruction Surgery Procedure

1. Preoperative Preparation :- Before the surgery, the patient undergoes a thorough medical evaluation. This includes:

• Physical examination of the knee to assess instability and range of motion
• Imaging tests such as MRI and X-rays to confirm the ACL tear and identify associated injuries like meniscus or cartilage damage
• Blood tests and routine health screening
• Review of medical history, medications, and allergies

Patients are usually advised to:

• Avoid food and drink for 6–8 hours before surgery
• Stop certain medications like blood thinners if recommended
• Perform pre-surgery physiotherapy (prehabilitation) to reduce swelling and strengthen muscles

This preparation helps improve surgical outcomes and speeds up recovery.

2. Anesthesia :- On the day of surgery, anesthesia is administered to ensure comfort and a pain-free procedure. The options include:

• General anesthesia – The patient is completely asleep
• Spinal or regional anesthesia – The lower body is numbed while the patient remains awake or lightly sedated

The anesthesiologist selects the most suitable option based on the patient’s health and surgical requirements.

3. Arthroscopic Examination of the Knee :- The surgeon begins the procedure by making small incisions (portals) around the knee. A thin instrument called an arthroscope, which contains a camera and light, is inserted into the joint.

This allows the surgeon to:

• View the inside of the knee on a monitor
• Confirm the ACL tear
• Identify and treat associated injuries such as:
  • Meniscus tears
  • Cartilage damage
  • Loose bone fragments

Any additional problems are treated before proceeding with ligament reconstruction.

4. Graft Harvesting (If Autograft is Used) :- If the surgeon is using the patient’s own tissue (autograft), the graft is harvested at this stage. Common graft sources include:

• Hamstring tendon
• Patellar tendon
• Quadriceps tendon

The selected tendon is removed through a small incision and prepared by trimming and strengthening it to match the size and strength required for the new ACL.

If a donor graft (allograft) is used, this step is skipped, and the prepared graft is taken from a tissue bank.

5. Removal of the Damaged ACL :- The torn ACL remnants are carefully removed using specialized arthroscopic instruments. The surgeon clears the area to create space for the new ligament while preserving surrounding healthy structures.
6. Creation of Bone Tunnels :- To secure the new ligament, the surgeon creates small tunnels in the:

• Femur (thigh bone)
• Tibia (shin bone)

These tunnels are placed in the exact anatomical position of the natural ACL to restore normal knee movement and stability. Proper tunnel placement is critical for the success of the surgery.

7. Placement of the Graft :- The prepared graft is then passed through the bone tunnels to replicate the original ACL’s position.

Once positioned correctly, the graft is secured using fixation devices such as:

• Screws (metal or bioabsorbable)
• Buttons or anchors
• Pins or other fixation systems

These devices hold the graft firmly in place while it gradually integrates with the bone and becomes a new functioning ligament.

8. Checking Knee Stability and Movement :- After fixation, the surgeon moves the knee through its full range of motion to ensure:

• Proper tension in the graft
• Smooth knee movement
• Adequate stability

This step confirms that the reconstruction has been successfully completed.

9. Closure of Incisions :- Once the procedure is finished:

• Arthroscopic instruments are removed
• The small incisions are closed using stitches or surgical tapes
• A sterile dressing is applied
• A knee brace may be placed to provide support and protection

The entire surgery usually takes 60 to 90 minutes, depending on the complexity and associated injuries.

10. Postoperative Care and Recovery :- After surgery, the patient is moved to the recovery room for monitoring. Most ACL reconstruction procedures are performed as day-care surgery, allowing patients to go home the same day or the next day.

Initial recovery includes:

• Pain management with medications
• Ice therapy to reduce swelling
• Elevation of the leg
• Use of crutches for support

Physiotherapy begins soon after surgery and is essential for:

• Restoring range of motion
• Strengthening muscles
• Improving balance and stability
• Gradual return to normal activities

Recovery timeline:

• Walking without support: 2–4 weeks
• Light activities: 6–12 weeks
• Running: 3–4 months
• Return to sports: 6–9 months (depending on progress)

Conclusion

ACL reconstruction surgery is a well-established and highly effective procedure for treating ligament tears and restoring knee stability. The arthroscopic technique, combined with precise graft placement and structured rehabilitation, allows most patients to return to their normal lifestyle and physical activities. Choosing an experienced orthopedic surgeon and following a proper recovery plan are key factors in achieving the best long-term results and preventing future knee injuries.