ACL Replacement Surgery
Dear Patient,
For optimal treatment, information regarding ACL replacement surgery follows.
Why should surgery be performed?
Previous examinations have shown instability in your knee joint following an anterior cruciate ligament tear. The cruciate ligaments are important stabilizers of the knee joint. With continued athletic or increased daily strain, meniscus damage and cartilage injuries are to be expected as secondary damage, and early-onset osteoarthritis may develop.
To regain full load-bearing capacity, the anterior cruciate ligament must be replaced with autologous tissue to stabilize the knee joint. For this purpose, one, rarely two, tendons are harvested from the posteromedial thigh. Alternatively, a graft from the patellar tendon, the quadriceps tendon, a portion of the lateral long peroneal tendon, or a human donor tendon can be chosen.
How is the surgery performed?
We perform the cruciate ligament surgery endoscopically, minimally invasively (keyhole technique), under general anesthesia or spinal anesthesia/epidural.
During the procedure, meniscus damage and cartilage damage are first addressed. The meniscus may also need to be sutured or the cartilage repaired. A tissue strip, as mentioned above, is harvested from a skin incision, from which the replacement cruciate ligament is prepared.
Using specialized targeting devices, drill holes are made into the tibial head and femur at the attachment site of the anterior cruciate ligament. After checking the position of the drill channels and smoothing the entry points, the pre-tensioned replacement cruciate ligament is inserted and secured with screws or titanium buttons.
An antibiotic is administered before ACL replacement surgery to prevent infections.
After the surgery, a knee brace with a cold compress is applied. With a brace, the knee can be partially weight-bearing immediately after the operation. The inserted wound drains are removed after approx. 24 hours. The sutures are removed after 10–14 days.
Physiotherapeutic treatment begins immediately after ACL replacement surgery with targeted muscle-strengthening and swelling-reducing exercises.
Generally, the knee can be weight-bearing without support after 2 weeks.
Lighter work is usually permissible after approx. 4 weeks, and heavier physical work after 10–12 weeks. Full athletic activity is permitted again after approx. 6-8 months.
Possible Complications:
- Infection of the joint and/or soft tissues (wound healing disorders)
- Late infections
- Venous thrombosis in the upper and lower leg, with embolisms (blood clots with vascular occlusion) as a rare consequence
- Re-rupture
- Implant failure
- Permanent restriction of movement (flexion and/or extension restriction)
- Remaining instability
- Lysis – graft failure due to autologous dissolution/weakening
- Nerve injury with subsequent sensory disturbance, for example, in front of the kneecap or on the inner side
- Vascular injury with persistent swelling of the joint
- Hematoma on the thigh, or skin injury due to the tourniquet for bloodlessness
- Wide scars
- Very rarely, rupture of the patellar tendon (kneecap tendon) or fracture of the kneecap after graft harvesting
- Persistent pain and/or feeling of instability
I have been informed about the nature, extent, and risks of the procedures listed above. Other treatment methods, their advantages and disadvantages, their chances of success, and their potential complications have been discussed.
After weighing the risks of medical treatment against the consequences of its omission, I have decided in favor of the planned ACL replacement surgery and agree to the planned procedure and any potential extension of the procedure depending on the findings during the operation. I have no further questions.
