Anterior Cruciate Ligament Tears and Their Treatment: arthroscopic and minimally-invasive surgery for ACL reconstruction
Edited By: Christopher J. Wahl, M.D., Suzanne L. Slaney, PA-C, ATC, MMS
Last updated Friday, October 20, 2006
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Preparing for surgery
Preparation
Surgical ACL reconstruction is considered for healthy and
motivated individuals in whom instability interferes with normal function and
activity.
Successful surgery depends upon a partnership between the
patient and the experienced knee surgeon.
When possible, patients should optimize their health to prepare for
surgery. Smoking should be stopped prior
to surgery, and be avoided altogether for at least three to six months
following surgery. Any heart, lung,
kidney, bladder, tooth, or gum problems and concomitant injuries to the skin or
extremity should be managed before the surgery.
Any active infections will delay elective surgery to optimize the benefit
and reduce the risk of joint infection.
The surgeon should be made aware of any health issues, including
allergies and non-prescription and prescription medications being taken. Some medications will need to be stopped
prior to surgery. For instance, aspirin
and anti-inflammatory medications (Advil®, Motrin®, Aleve®, and other
non-steroidal anti-inflammatory drugs) should be discontinued as they will
affect intra-operative and postoperative bleeding.
Before surgery, patients should consider the limitations,
alternatives and risks to surgery.
Individuals must recognize that the procedure is a process and
not an event; the benefit of the surgery largely depends on the
patient’s willingness to apply effort to rehabilitation after surgery.
Patients must plan on being less active and functional for
6 to 8 weeks after the surgery. Plans
for necessary assistance need to be made before surgery. Patients will be able to walk with assistive
devices (knee brace and crutches) immediately after surgery. Jogging activities are rarely resumed before
15 weeks. A full return to cutting
sports is usually possible by 6-months.
Timing
There is not a definite time period that should be
considered before undergoing an arthroscopic ACL reconstruction. When considering when to perform ACL
reconstruction, it is not usually defined by time, but rather by the condition
of the knee. If the knee has significant
inflammation or decreased range of motion, then it is recommended to delay the
surgery until these factors have been remedied with pre-operative
rehabilitation.
Additionally, it is best to not wait for an extended
period of time before undergoing an ACL reconstruction. Since the knee is most likely “unstable”, it
is important to reduce the occurrence of injury to other knee structures such
as the menisci, collateral ligaments, and articular cartilage. Additionally, a chronically unstable knee can
predispose an individual to early arthritis.
However, it must be noted that the arthritis can not necessarily be avoided
by ACL reconstruction.
Costs
The surgeon’s office should provide a reasonable estimate
of the:
- Surgeon fee
- Hospital fee
- Degree to which these services should be covered
by the patient’s insurance
Surgical team
Patients should
inquire as to the specific training the surgeon has undergone to perform such
procedures (i.e. a fellowship-trained, sports medicine specialist familiar with
arthroscopic techniques and equipment).
In addition, it is useful to know how many of these procedures the
surgeon and the medical center perform on a yearly basis.
The
surgical team of an experienced, specially trained orthopedic surgeon and
certified physician assistant (PA-C) can dramatically improve the quality of
care received by the patient. The
interdependent physician-PA team ensures continuity of patient healthcare,
commitment to personalized treatment, and makes certain patients will have
greater access to care. The goal of this
team is to magnify the efficiency and safety in the operating room and clinic, and
to make certain the patient in receiving superior and quality care.
Finding an experienced surgeon
While surgeons who are capable of performing simple
arthroscopic procedures are relatively easy to find, reconstructive surgeries
in the knee demand a degree of highly specialized training. Many capable surgeons will have completed a
fellowship (additional year or two of training) specifically in arthroscopic
techniques, knee surgery and sports medicine.
A qualified sports medicine surgeon should be comfortable with
arthroscopic techniques, autograft harvesting, and tailor the appropriate
treatment to the problem to be addressed.
It is helpful to find a surgeon who is familiar with a number of
different reconstruction techniques (single- and double-bundle) and graft types
(hamstring, bone-patellar tendon-bone, quadriceps, and allograft). Fellowship-trained surgeons may be located
through university schools of medicine, medical societies, or state orthopedic
societies. Other resources include
professional societies such as the American Orthopedic Society for Sports
Medicine (AOSSM) or the American Academy of Orthopedic Surgeons (AAOS), Arthroscopy
Association of North America (AANA), and American College
of Sports Medicine.Facilities
Arthroscopic ACL reconstruction is usually performed in a
qualified ambulatory surgical center or major medical center that performs such
procedures on a regular basis. These
centers have surgical teams, facilities, and equipment specially designed for
this type of surgery. For those patients
who require an overnight stay, the centers have nurses and therapists who are
accustomed to assisting patients in their recovery from arthroscopic knee
surgeries.
Surgery for Anterior cruciate ligament - ACL - tear at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-543-1552 or 425-646-7777 to make an appointment. Our clinical center is located in Seattle Washington, USA
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