Your knee is a complex and crucial joint, and the ligaments within it play a vital role in its stability and movement. Two of the most important are the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). These strong bands of tissue cross in the middle of your knee, with the ACL at the front and the PCL at the back. They work together to control the back-and-forth motion of your knee.
Unfortunately, these ligaments can be injured, especially during sports or accidents. A tear in the ACL or PCL can cause pain, swelling, and a feeling that your knee is unstable or “giving way.” While some minor tears can be treated with non-surgical methods, more severe injuries often require surgery to reconstruct the torn ligament. This procedure is known as ACL or PCL reconstruction.
At California Pacific Orthopaedics, our team of expert surgeons in the San Francisco Bay Area specializes in these complex procedures. We use the latest techniques and technology to help you regain stability, reduce pain, and get back to the activities you love.
Why is ACL or PCL Reconstruction Done?
The main reason for ACL or PCL reconstruction is to restore stability to the knee. Without a functioning ACL or PCL, your shinbone can slide too far forward or backward in relation to your thighbone. This instability can make it difficult to walk, run, or even stand without your knee feeling like it might buckle.
Reconstruction is often recommended for:
- Active Individuals: If you’re an athlete or have a physically demanding job, a torn ACL or PCL can significantly impact your ability to perform. Reconstruction can help you return to your previous level of activity.
- Multiple Ligament Injuries: If you’ve injured other ligaments in your knee in addition to your ACL or PCL, surgery is often necessary to repair all the damaged structures.
- Chronic Instability: If you’ve tried non-surgical treatments like physical therapy and bracing, but your knee still feels unstable, reconstruction may be the best option.
- Preventing Future Damage: An unstable knee is at a higher risk for further injury, including damage to the cartilage and meniscus. Reconstructing the ligament can help prevent these long-term complications and reduce the risk of developing osteoarthritis.
Our surgeons at California Pacific Orthopaedics will conduct a thorough evaluation, including a physical exam and imaging tests like X-rays and MRI, to determine if ACL or PCL reconstruction is the right choice for you.
What to Expect Before, During, and After the Procedure
Before the Procedure
Once you and your surgeon have decided that reconstruction is the best course of action, you’ll begin preparing for the surgery. This may include:
- Pre-habilitation: You may be asked to do physical therapy before surgery. The goal is to reduce swelling, improve your knee’s range of motion, and strengthen the surrounding muscles. A stronger, more flexible knee going into surgery often leads to a better outcome.
- Medical Evaluation: You’ll have a complete medical evaluation to ensure you’re healthy enough for surgery. This may include blood tests, an EKG, and a review of your medical history.
- Medication Adjustments: Your doctor will review your current medications and may ask you to stop taking certain ones, like blood thinners, before surgery.
- Arranging for Help: You’ll need to arrange for someone to drive you home from the hospital and help you around the house for the first few days after surgery.
During the Procedure
ACL and PCL reconstruction is typically performed using a minimally invasive technique called arthroscopy. Here’s what happens during the surgery:
- Anesthesia: You’ll be given anesthesia to ensure you’re comfortable and pain-free during the procedure. This could be general anesthesia (where you’re asleep) or regional anesthesia (which numbs your lower body).
- Small Incisions: Your surgeon will make a few small incisions around your knee.
- Arthroscope: A small camera called an arthroscope is inserted into one of the incisions. This allows the surgeon to see the inside of your knee on a monitor.
- Removing the Torn Ligament: The damaged ligament is removed using small surgical instruments inserted through the other incisions.
- Graft Placement: A new ligament, called a graft, is put in its place. The graft can be a tendon taken from another part of your body (like your patellar tendon, hamstring, or quadriceps tendon – aka: autograft) or from a donor/cadaver (aka: allograft).
- Securing the Graft: The graft is passed through tunnels drilled into your thighbone and shinbone and then secured with screws or other fixation devices.
- Closing the Incisions: The small incisions are closed with stitches or surgical strips. .
The entire procedure usually takes a couple of hours, and most patients can go home the same day.
After the Procedure
Recovery from ACL or PCL reconstruction is a gradual process that requires patience and commitment to rehabilitation. Here’s a general timeline of what to expect:
- Immediately After Surgery: You’ll be in a recovery room where your vital signs will be monitored. Your knee will be bandaged, and you may be in a brace. You’ll be given pain medication to manage any discomfort.
- The First Few Weeks: The focus during this time is on reducing pain and swelling, protecting the new graft, and regaining your knee’s range of motion. You’ll likely be on crutches and wearing a brace. You’ll also start physical therapy, where you’ll learn exercises to do at home as well. It is important to continue to ice and elevate at this time to help with the pain and reduction of swelling. You will be able to slowly weightbear as the pain improves.
- One to Three Months: As you continue with physical therapy, you’ll gradually increase the intensity of your exercises to build strength and stability in your knee. You’ll likely be able to stop using crutches and the brace during this time. It is crucial to avoid certain activities that can put more strain on your new ACL/PCL graft, as this can cause reinjury/tear to the new graft. Your provider can go over this with you. Some of these include: wall sits, ambulating downhills, and lunges, just to name a few.
- Three to Six Months: You’ll continue to work on strengthening and conditioning, and you may be able to start some light jogging and other low-impact activities.
- Six Months and Beyond: Depending on your progress, your surgeon and physical therapist may clear you to return to sports and other high-impact activities. Full recovery can take anywhere from eight months to a year.
The team at California Pacific Orthopaedics will be with you every step of the way, from your initial consultation to your final follow-up appointment. We’re committed to providing you with the highest quality of care and helping you achieve the best possible outcome from your ACL or PCL reconstruction.
If you’re experiencing knee pain or instability, don’t wait. Contact California Pacific Orthopaedics today to schedule an appointment with one of our knee specialists at our San Francisco office.
