ACL Reconstruction - Houston, Beaumont, Cypress TX
A torn ACL is a common sports injury that causes a feeling of instability in the knee or leads to debilitating pain. These effects happen because the anterior cruciate ligament (ACL) is designed to keep the knee stable and control joint movement.
The ACL, which is made up of a strong rope-like structure, is one of the four ligaments that hold the bones in your knee together.
Two of the ligaments, referred to as the collateral ligaments, are located on the side of the knee, and the other two are situated inside the knee. The ACL is one of the two ligaments located in the center of the knee. It crosses over the other ligament, called the posterior cruciate ligament (PCL), and runs all the way from the femur to the tibia.
If this ligament tears slightly, you may be able to heal some of the discomfort and pain through rest and physical therapy. However, anterior cruciate ligament reconstruction is usually necessary to correct the tear and repair the ligament.
What Causes ACL Tears?
Tearing or injuring the ACL during sporting activities is common. Sports like football, basketball and soccer can involve pivoting or cutting motions that can tear the ligament. Athletes can easily twist or overextend their knees during those movements. During these sports, direct contact to the side of the knee with another player can cause injury to the area.
Along with sports, anything from out-of-control play to work accidents can cause an ACL injury. Any time someone experiences an awkward landing, makes a sudden directional change or takes a jerky, sidestepping movement, they can tear their ACL.
While anyone can experience an ACL tear, the injury is more common in women. This fact can be due to factors ranging from estrogen's influence on ligaments to the lower leg and pelvis alignment.
What Are the Symptoms of an ACL Tear?
While the symptoms of an ACL tear can vary, most people feel a popping sensation or hear a snap in their knee right when the injury occurs. Some individuals may feel tenderness or discomfort, while others may find the pain debilitating. Due to the discomfort and pain, most individuals cannot continue the activity.
The knee can swell rapidly within the first few hours following the injury, especially if it's not iced right away. The swelling is due to the bleeding that occurs within the torn ligament. Other symptoms include instability and a loss of full range of motion during any activity requiring the injured leg to bear weight. It may even feel like the knee gives way when walking or changing direction.
What Are Risks and Complications With ACL Surgery?
Possible risks and complications associated with ACL reconstruction with the hamstring method include:
- Blood clots (deep vein thrombosis)
- Nerve and blood vessel damage
- Failure of the graft
- Loosening of the graft
- Decreased range of motion
- Crepitus (crackling or grating feeling of the kneecap)
- Knee pain
- Repeat injury to the graft
How Do You Diagnose an ACL Tear?
Sometimes, a physician can diagnose an ACL tear by just the patient's history. Most practitioners, though, will perform at least a physical examination to look at the patient's range of motion and whether there's any instability.
A physicians may use X-rays to look for fractures. An MRI scan can help practitioners gain a closer and more detailed look at the cartilage and meniscus tissue to diagnose an ACL tear. This process also allows physicians to see if other structures, like the collateral ligaments, within the knee are damaged.
Physicians also use the Lachman's test, which can show increased forward movement of the tibia and a soft endpoint. Compared to a healthy knee, these results can indicate whether the ACL is intact or torn.
Similarly, the pivot shift test will show if the tibia moves forward when the knee is straight and if the knee bends past 30 degrees when the tibia shifts back into the right place. If these happen, the ACL is likely torn.
Other times, a physician may only be able to diagnose an ACL tear if the patient is under general anesthetic. Arthroscopy is one type of diagnostic test that uses a small fiber-optic video camera to take a closer look at the ligament.
Regardless of the method a physician uses to diagnose an ACL tear, most cases will require surgery to reconstruct the tear.
What Are the Types of ACL Surgeries?
ACL reconstruction surgery is a common procedure that tightens the knee ligaments and restores stability. Thanks to advances in arthroscopic surgery, the complication rates for these surgeries are low.
Because swelling generally accompanies this injury, most ACL reconstruction surgeries take place three to eight weeks after the injury. During this time, the swelling tends to decrease, and some movement is restored through rehabilitation. This partial healing helps prevent stiffness and scar formation following the procedure.
The three main types of ACL surgeries are:
- ACL Reconstruction Hamstring Tendon
- ACL Reconstruction Patellar Tendon
- ACL Reconstruction with a Bone-Patellar Tendon-Bone (BPTB) Graft
ACL Reconstruction Hamstring Tendon
Anterior cruciate ligament reconstruction hamstring method is a surgical procedure to replace the torn ACL with part of the hamstring tendon taken from the patient’s leg. The hamstring is the muscle located on the back of your thigh. The procedure is performed under general anesthesia.
Your surgeon will make two small cuts about 1/4-inch long around your knee. An arthroscope, a tube with a small video camera on the end is inserted through one incision to see the inside of the knee joint. Along with the arthroscope, a sterile solution is pumped into the joint to expand it enabling the surgeon to have a clear view and space to work inside the joint.
The knee is bent at right angles and the hamstring tendons are felt. A small incision is made over the hamstring tendon attachment to the tibia and the two tendons are stripped off the muscle and the graft is prepared.
The torn ACL will be removed and the pathway for the new ACL is prepared. The arthroscope is reinserted into the knee joint through one of the small incisions. Small holes are drilled into the upper and lower leg bones where these bones come together at the knee joint. The holes form tunnels in your bone to accept the new graft.
Then the graft is pulled through the predrilled holes in the tibia and femur. The new tendon is then fixed into the bone with screws to hold it into place while the ligament heals into the bone. The incisions are then closed with sutures and a dressing is placed.
ACL Reconstruction With a Bone-Patellar Tendon-Bone (BPTB) Graft
The procedure is performed under general or local anesthesia. Your doctor will first evaluate your knee under anesthesia to assess the damage to the ACL and other structures. Following this, a portion of the patellar tendon along with its area of attachment to the shin bone and kneecap is obtained and prepared to be used as a graft.
Small incisions are then made over the knee to insert an arthroscope and other surgical instruments. The arthroscope consists of a tube with a light and camera to view the inside of the joint. The structures within the knee are evaluated and any significant injuries are identified and repaired during the surgery. Tunnels are created by drilling through the shin bone and thigh bone.
The graft is passed through these tunnels and secured with screws to replace the original ACL. The incisions are then closed with sutures and covered with dressings. The procedure takes about 1-1/2 to 2 hours.
ACL reconstruction with a “bone-patellar tendon-bone” graft has the advantage of better outcomes when compared to other forms of therapy or other grafts and the patellar graft is also easily obtained.
Disadvantages of this surgery include pain in front of the knee, especially with kneeling, from harvesting the patellar tendon. The procedure is not recommended for children with growing bones.
What to Expect After ACL Reconstruction
Following the surgery, rehabilitation begins immediately. A physical therapist will teach you specific exercises to be performed to strengthen your leg and restore knee movement. Avoid competitive sports for five to six months to allow the new graft to incorporate into the knee joint.
Anterior cruciate ligament reconstruction is a very common and successful procedure. It is usually indicated in patients wishing to return to an active lifestyle especially those wishing to play sports involving running and twisting. Anterior cruciate ligament injury is a common knee ligament injury. If you have injured your ACL, surgery may be needed to regain full function of your knee.
Frequently Asked Questions
Are you interested in learning more about ACL reconstruction surgery? Here are some of our most frequently asked questions.
What's the Outlook?
ACL reconstructive surgery is a common procedure performed by specialists. With advances in technology, this surgery has a high success rate. While it's uncommon, there is a small risk of either medical or surgical complications from the procedure. Your surgeon will explain the risks and advantages of the surgery beforehand.
Typically, ACL surgery is a day procedure. Your physician will provide pain medication and possibly a splint to help with comfort and recovery.
When Will My Surgery Be Scheduled?
At Mufaddal Gombera, MD, our ACL reconstructive surgery doctors take a different approach to orthopedic injuries. Unlike other practices, we look at all options before recommending surgery. We then create a personalized treatment plan based on your specific needs. For some, non-surgical and conservative options will provide the relief and results they want.
If we think surgery is the best option, we'll get it scheduled as soon as possible.
How Much Does ACL Rebuild Surgery Cost?
The cost of anterior cruciate ligament surgery can vary based on several factors ranging from how involved the repair is to where you live.
The cost can also vary depending on whether or not you have insurance. Most insurance plans, including Medicaid and Medicare, will cover the procedure if it's medically necessary. The amount you pay out of pocket can vary based on your coverage.
What Will Rehab Include?
Most often, rehab includes physiotherapy to help reduce swelling and improve your knee's range of motion. Your physiotherapist may recommend activities like swimming or bike riding as part of your rehab treatment. You'll most likely have some muscle strengthening and proprioceptive exercises to perform as well.
Your physiotherapist will watch you closely throughout the process and ensure you do everything safely and effectively. Rehab and recovery can vary based on several factors like damage to the articular cartilage.
Schedule Your ACL Reconstruction Surgery
At Mufaddal Gombera, MD, we provide specialized and personalized treatments to heal your pain and injuries. Mufaddal M. Gombera, MD, a board-certified, fellowship-trained orthopedic surgeon, can help you return to your active lifestyle with anterior cruciate ligament surgery.
By relying on the latest advanced treatments and minimally invasive techniques, you can expect a shorter and more smooth recovery.
Contact us today to schedule your ACL reconstructive surgery.