What, Exactly, Will Happen During Surgery For An Anterior Cruciate Ligament (ACL) Injury?

July 1, 2009— -- Question: What, exactly, will happen during surgery for an anterior cruciate ligament (ACL) injury?

Answer: Surgery for ACL tears or to reconstruct the anterior cruciate ligament has come a long way in the last 15 years. We do the surgery arthroscopically, in other words we don't have to open up your knee joint to reconstruct the ligament. We can do it through two or three small quarter-inch incisions in the knee. We do have to make a slightly bigger incision down below the knee and make a little trap door to get the new ligament up into the knee without opening the knee joint. But again, most of the surgery, or all of the surgery in the knee joint proper, is done through these two small incisions -- arthroscopically.

What we do is we take a graft, and that can be either from your own knee, such as from the patellar tendon or from a donor -- from donor tissue or cadaver tissue -- and build the new ligament. We then anchor that ligament into the femur bone, the end of your femur bone and the top of your tibia bone, at the sites that your original ligament used to connect, originate from, and insert into. And we make little drill holes into the bones to anchor that new graft or your new ligament into place.

We use specialized screws or pins to hold that ligament in the bone tunnels until it heals, which takes about six or eight weeks. Those screws or pins are either permanent, made out of titanium or made out of a substance that will be reabsorbed by the body over the course of one or two years. And so there's no secondary surgery that's needed to remove any pins or screws after the ligament has healed.

The surgery, in general, takes about an hour to an hour-and-a-half, and in most situations is done as an outpatient; in other words, you'll come in to the hospital or surgical center about an hour-and-a-half before your procedure, meet the anesthesiologist, get set up for the procedure. And then after the procedure is done, they'll keep you in the recovery room for about an hour or so, and then let you go home on crutches. So, all told, you might be in the hospital three or four hours for this procedure.