1. ACL Reconstruction Surgery
By: Alexis Kaufusi

2. What is an ACL?
The ACL is known as the Anterior Cruciate Ligament of the knee. It connects from a posterio-lateral part of the femur to an anterio-medial part of the tibia. It passes up, backward, and laterally, and is fixed into the medial and back part of the lateral condyle of the femur.

3. What is the function of the ACL?
The ACL is the main stabilizing ligament in the knee. When it is torn, your ability to do movements such as cutting, jumping, and other lateral movements become impaired and cannot be done. The ACL holds the knee together while keeping it stable making everyday activities possible.

4. How do you tear you’re ACL?
When your tear your ACL you tear the central stabilizing ligament in the knee. If you plant your foot to pivot or change directions, your knee will probably feel as if it will give out on your or cause the knee to feel as if it won't support you. Sometimes the knee may feel as if it "hyper-extends".
ACL tears most often occur during running, cutting, or similar sports-like activities. It may however occur in all types of activities. When it occurs, often you feel as if your knee gave out on you or hyper-extended. It is usually associated with the sensation of a "pop". The knee tends to swell immensely within the first 24 hours.

6. What is ACL Reconstruction surgery?
The knee will be painted with antiseptic solution to reduce the risk of infection. You will also be administered antibiotic medication through your IV.
Three small puncture wounds are made in the front of your knee.
One is for the scope or camera which allows a view of the inside of your knee.
One is for the instruments used to remove the torn part of the meniscus.
One is for a small fluid drain tube.
Then remnants of the torn ACL are removed and reconstruction of the ACL is begun.

7. What are the option for ACL grafts?
Patellar Tendon
Hamstring Tendon
Allo-graft

8. Patellar Tendon Graft
This graft is the most common especially for athletes. The graft is taken from the patellar tendon and thread up through and tibia and attached at the femur. The downside to this graft is that many people experience patellar tendonitis after surgery.

9. Hamstring Tendon
The Hamstring tendon is taken from the back of the knee and thread down through the knee and connecting at the tibia. The downside to this graft is the loss of extension when it is used.

10. Allograft
The allograft is a common graft used after your first ACL tear. By using this graft the recovery is usually faster but the body sometimes doesn’t respond to the graft as well since it is from a cadaver.

11. Post-Surgery
After surgery, you are given some pain killers and an icing machine to help once the “block” wears off. The key to the first week is RICE. Rest, Ice, Compression, and Elevation. An ice and compression sleeve is usually wrapped on after surgery making icing easier. Its important to never get up on your own and to make sure someone is with you when you are moving around.

12. Physical Therapy
Physical Therapy is a key component to recovering from an ACL tear. Without physical therapy it will be hard to continue most if not all functions with your leg. Recovery normally takes anywhere from 8 to 16 months depending on the severity of the tear.

13. Testing Strength
The ACL strength can be tested two ways. The first is called the KT test. This test will determine and strength of the graft. The second is called the cybex test. This will test the overall strength of not only your graft but your leg as well. Once you have reached the 90th percentile, athletes are cleared to compete at 100%.

14. Bracing
Bracing is the smartest and safest way to protect your knee after surgery. There are many different braces used. There are soft, hard, and customized. Athletes who plan to compete within a year after surgery are recommended to get a customized brace and wear it till their knee is completely stable and strong. Although braces can be pricey, they help in the long run.

15. References
Brent Butler, PT
Kirt Kimball, MD