Anterior Cruciate Ligament (ACL) Reconstruction Surgeon

Head Sports Medicine Physician Nikhil Verma, MD

Are you an athlete who participates in sports that involve jumping or quick stopping? If so, you may be at risk of tearing your anterior cruciate ligament, or ACL. An ACL injury is one of the most common injuries suffered by athletes. ACL surgeon, Dr. Nikhil Verma provides diagnosis and both surgical and nonsurgical treatment options for patients in Chicago who have suffered an ACL injury. Contact Dr. Verma’s team today!

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An Overview on Anterior Cruciate Ligament Reconstruction
(ACL Reconstruction)

The anterior cruciate ligament (ACL) is one of the four main ligaments responsible for stabilizing the knee. The other ligaments include the posterior cruciate ligament (PCL), medial collateral ligament (MCL) and posterior lateral complex (PLC). The ACL is located at the front of the knee joint (anterior) and crosses (cruciate) in front of the PCL. Responsible for assisting with stability during rotational movements and twisting, the ACL is the most commonly torn knee ligament. Athletes are more prone to an ACL injury since they are heavily involved in running, acceleration and deceleration, and sudden cutting movements. When an ACL injury or tear occurs and requires surgery, an ACL surgery may be recommended. Highly experienced in ACL reconstruction surgery, Dr. Nikhil Verma, knee surgeon in the Chicago, Westchester, Oak Brook and Hinsdale, Illinois area, can help professional athletes and the general, active population return to the activities they love following an injury.

In most cases, an ACL injury occurs as a result of an acute traumatic event. Over 70% of these injuries are non-contact, meaning the athlete injures themselves without contact from another player. Most patients experience a popping sound at the time of the ACL injury and notice sudden swelling and pain in the affected knee. The injury is followed by a sense of instability and difficulty with range of motion in the knee.

When an injury occurs to this ligament, an ACL reconstruction is typically recommended by Dr. Verma. The ACL has a poor blood supply and due to the general anatomy of the knee, the ligament does not heal naturally on its own. The decision to proceed with surgery is dependent on the age and desired activity level of the injured person. In most cases, reconstruction is required if the patient wishes to return to high level contact, cutting or pivoting sports. ACL surgery stabilizes the knee while lowering the risk of future arthritis or meniscus tear.

PATIENTS WITHOUT INSURANCE

Dr. Verma participates in the MOR Package Pricing program for ACL Repair

ACL Repair Procedure Cost: $10,800

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Dr. Verma typically treats the ACL in an arthroscopic procedure. This procedure is less invasive and involves the use of tiny incisions, a camera and small surgical instruments to view and assess the knee and surrounding area. Dr. Verma will begin the torn ACL surgery by viewing the knee with the camera and determining the extent of damage. The ligament must then be reconstructed and not just repaired because of its limited healing ability. Dr. Verma will first remove the ligament’s damaged ends. He will then position a certain replacement graft in the former ACL site and attach it to the thigh and lower leg with adjustable buttons or screws. The goal of the ACL reconstruction is to place and secure the replacement graft precisely in the right location to reconstruct the damaged ligament.

There are two main types of grafts used in an ACL reconstruction, including:

  • Autograft: The donor tissue is harvested from the patient’s quadriceps tendon, patella tendon or hamstring tendon.
  • Allograft: The donor tissue is taken from a tissue bank.

The best graft option is determined by the age of the patient and desired activity level and is discussed during you pre-operative appointment.

Recovery and Rehabilitation after ACL Reconstruction

Patients will be placed in a knee brace and instructed to begin an ACL rehabilitation program immediately following the ACL surgery. Crutches are recommended for approximately two to four weeks following the procedure and a functional style of brace may be used for the first year after returning to activities. Patients can expect a full recovery and return to sports activities between six to nine months in the vast majority of cases.

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ACL Reconstruction FAQ

Does an ACL tear require surgery?

Some patients with an ACL tear may be able to avoid surgery by participating in a physical rehabilitation program which can restore the knee as closely as possible to its pre-injury state. Dr. Verma’s team will educate patients on how to prevent knee instability and will suggest the use of a hinged knee brace to prevent further injury during activities.

Are screws used in ACL reconstruction?

Yes, metal screws are used in most cases to secure the new ACL graft in most cases. If a hamstring tendon is utilized for the reconstruction, then buttons and sutures are often used.

What causes an ACL reconstruction to fail?

Orthopedic literature tells us the number one cause of an ACL reconstruction failure is an improperly placed graft during reconstruction. Another ligament problem at the time of ACL surgery, such as a posterolateral corner injury can also put additional stress on the ACL reconstruction graft and can lead to its failure. Fortunately, the failure rate of an ACL reconstruction is less than 10%.

The other major cause of failure is recurrent injury. Just like the native ligament, a reconstructed ACL can tear due to trauma or injury.

Can an ACL reconstruction be done twice?

Dr. Verma has extensive experience with revision ACL reconstruction to repair a failed ligament graft. ACL revision reconstruction is becoming more common each year but require an extensive pre-surgical assessment.

Which ACL surgery is best for athletes?

Athletes have a higher demand and put more stress on their knees than non-athletes. For this reason, Dr. Verma will often recommend a patellar tendon autograft as his graft choice for this type of ACL surgery. Athletes have proven results with a patellar tendon ACL reconstruction when placed in the correct position.

Does ACL reconstruction lead to knee replacement?

An ACL reconstruction without additional injuries does not lead to patients requiring a knee replacement. However, any knee injury and subsequent surgery does give the patient a 3 to 5 times greater risk of developing post-surgical arthritis in the knee. Dr. Verma suggests a full program of physical therapy to restore the strength of the surrounding muscles and hopefully, to avoid post-traumatic arthritis.

When can I start running after ACL surgery?

Healing and rehabilitation times after ACL surgery can vary greatly depending on the extent of the original injury. In general, the ACL graft will need 10-12 weeks to heal properly, followed by a specialized physical therapy protocol. Once the quadriceps muscle has strengthened and patients can demonstrate a single-leg squat without valgus collapse, patients may start running. The time frame for this averages 4-5 months after surgery.

Can you walk with a torn ACL?

In short, yes, you can walk with a torn ACL. However, as the main stabilizer in the knee, a complete tear of the ACL can make the joint very unstable.  Therefore ther is some risk of further injury if the knee continues to give way.

What are the different graft options for ACL reconstruction?

Tissue grafts for any type of reconstruction are usually separated into two categories: Autograft and Allograft. Autograft tissue comes from the patient and for ACL reconstruction can be a patellar tendon or a hamstring tendon. Allograft tissue is a donated ligament from a cadaver. Dr. Verma can discuss the risks and benefits of each type of graft for his patients in Chicago.

What happens if you don’t repair a torn ACL?

A partially torn ACL may not require surgery. Patients with a partial tear can safely perform many activities without problems. An ACL that is completely torn cannot heal by itself and if left untreated, will cause knee instability and chronic ACL deficiency can develop. As a result, further damage to the meniscus or cartilage can occur.

How long is the recovery from ACL reconstruction?

For a successful ACL reconstruction, patients need to commit to a recovery phase, including a strict post-operative protocol and rehabilitation. An ACL graft needs time to heal and the patient will need to strengthen the surrounding muscles as well as regain full range of motion in the knee. Dr. Verma’s patients typically return to full activities in about 7-9 months.

Is ACL surgery a major surgery?

ACL reconstruction surgery, although common, is considered a major surgery. Rehabilitation after an ACL reconstruction takes time and effort for patients to complete the required physical therapy program and return to normal work and play activities.

How long until you can walk after ACL reconstruction?

Patients will use crutches immediately after surgery but can place weight on the repaired knee as tolerated. Weaning off of the crutches can take 2-3 weeks, at which time patients should be able to walk without limping.

For additional information on the treatment for a torn ACL, or to learn more about ACL reconstruction surgery, please contact the office of Dr. Nikhil Verma, orthopedic knee surgeon serving the communities of Chicago, Westchester, Oak Brook and Hinsdale, Illinois.

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