What is anterior cruciate ligament reconstruction?

Anterior cruciate ligament (ACL) surgery replaces the damaged ligament with a new ligament called a graft. In most cases, the graft is a tendon taken from your own knee or hamstring. In some cases, the graft comes from a donor.

Your doctor uses a lighted tube called an arthroscope, or scope. He or she puts this and other surgical tools through small cuts in your knee. Your doctor may make a larger cut to take the graft from your knee or hamstring. He or she then replaces the ACL with a graft. The cuts are called incisions. They leave scars that usually fade with time.

Most people go home on the same day of the surgery or the next day. Your knee will slowly get stronger as you recover. You may be able to go back to most of your normal activities within a few weeks. But it will be months before you have complete use of your knee. It may take as long as 6 months before your knee is ready for hard physical work or certain sports.

You will need physical rehabilitation (rehab) after surgery. This will build your strength and improve the motion of your joint. At first, you will get help with the exercises. Later, you will get exercises to do on your own. The rehab will last for several months. After surgery and rehab, you should have less pain and your knee should be more stable. Your knee should not give out or buckle.

How soon you can return to sports or exercise depends on how well you follow your rehab program and how well your knee heals. If you had a partial meniscectomy, you might be able to play sports in about 1 to 2 months. If you had meniscus repair, it may be 3 to 6 months before you can play sports.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

What happens before surgery?

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctors ALL the medicines and natural health products you take. Some of these can increase the risk of bleeding or interact with anesthesia.
• If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if you should stop taking these medicines before your surgery. Make sure that you understand exactly what your doctor wants you to do.
• Your doctor will tell you which medicines to take or stop before your surgery. You may need to stop taking certain medicines a week or more before surgery. So talk to your doctor as soon as you can.
• If you have an advance care plan, let your doctor know. Bring a copy to the hospital. If you don't have one, you may want to prepare one. It lets your doctor and loved ones know your health care wishes. Doctors advise that everyone prepare these papers before any type of surgery or procedure.
• You will have a chance to talk to your physiotherapist. Physical rehabilitation is a big part of your recovery. Your therapist may teach you some exercises that will help prepare your knee for surgery.

What happens on the day of surgery?

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be cancelled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewellery and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery centre

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take about 1 to 3 hours.
• Your leg may be in a leg brace to limit motion.
• You may have a device that applies cold treatment to your knee.
• You will have crutches for 1 to 2 weeks. It may help to have a backpack or another way to carry items.

Going home

• Be sure you have someone to drive you home. Anesthesia and pain medicine make it unsafe for you to drive.
• You will be given more specific instructions about recovering from your surgery. They will cover things like diet, wound care, follow-up care, driving, and getting back to your normal routine.

When should you call your doctor?

• You have questions or concerns.
• You don't understand how to prepare for your surgery.
• You become ill before the surgery (such as fever, flu, or a cold).
• You need to reschedule or have changed your mind about having the surgery.