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ACL Reconstruction

What is Arthroscopic ACL reconstruction?

Arthroscopic ACL reconstruction is the gold standard surgical treatment for complete ruptures (tears) of the ACL in active, symptomatic patients. ACL reconstruction is a minimally invasive arthroscopic surgical procedure to rebuild the ACL with a graft typically made from the patient’s own tendon called an autograft. The patellar tendon, hamstring tendons, and quadriceps tendon grafts are the most commonly used autografts for ACL reconstruction. In patients that are older and have lower physical demands, a graft from a donor, an allograft could be an option.

ACL reconstruction surgery is performed over 200,000 times a year in North America. Reconstruction of complete tears of the ACL is able to restore nearly natural biomechanical function in symptomatic patients. ACL reconstruction is a common surgery, and most patients return to their preinjury activities after surgery and rehabilitation.

Your HyperRegen Sports Medicine healthcare professional will have preferences about the specific type of autograft that will be used including patellar tendon, quadriceps tendon or hamstrings autograft. They always personalize their approach to graft choice in line with each patient’s goals, values and priorities. Many factors including age, activity level, sex, ligamentous laxity, prior surgical history and the patient’s interests influence graft choice. In some instances (e.g. revision surgery, high grade laxity), a portion of the iliotibial band may be used to augment the ACL reconstruction in a procedure called a lateral extra-articular tenodesis (LET). Ultimately, the choice of graft is a shared decision made with each patient.

ACLR is an outpatient procedure performed under general or regional anesthesia.  After a careful exam under anesthesia, the autograft of choice (e.g. patellar tendon) is harvested through an incision at the front of your knee.  Following this, a fiber-optic video camera is inserted into your knee to visualize your cartilage, medial and lateral menisci, and ligamentous structures.  After treating for any meniscal or cartilage injury, small sockets are created in the femur and tibia following which the ACL autograft is inserted and secured with small screws.  At the end of the case, your surgeon tests the knee’s range of motion and the security of the graft.

The incisions are closed, and the knee is placed into a stabilizing brace. Patients go home the same day with crutches.

In the first several weeks following surgery, patients will work with their physical or athletic therapist to restore range of motion, decrease swelling, and optimize quadriceps activation. During the next phase, there will be more emphasis on restoring strength, proprioception and optimizing mobility.  Jogging usually commences after 3 months when swelling has completely resolved, and sports specific activities commence in the weeks and months thereafter.  Patients are permitted to return to sports approximately nine months following ACL reconstruction. The decision regarding exact timing can vary on a case-by-case basis but takes into consideration several factors including knee stability, absence of pain and swelling, quadriceps and hamstring strength, performance on functional tests, and psychological and functional readiness as determined by our return to sport testing protocol at HyperRegen.

At a Glance

Dr. Jas Chahal

  • Head of Orthopaedic Surgery, Women’s College Hospital
  • Team Physician Toronto FC and University of Toronto Varsity Blues
  • Associate Professor, University of Toronto Orthopaedic Sports Medicine Program
  • Has more than 100 peer-reviewed publications
  • Learn more

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