ACL refers to the Anterior Cruciate Ligament. Anterior Cruciate Ligament with other four main ligaments located in the knee. The knee joint is held together by Medical Collateral Ligament , Lateral Collateral Ligament , Anterior Cruciate Ligament and Posterior Cruciate Ligament.

Being located in the centre of the knee, it helps to keep the shin bone or tibia in place. An ACL reconstruction is a tissue graft surgery to reconstruct or repair the ligament of the knee. A tear of this ligament can become a hazard in your physical activities.

The particular cruciate ligament is usually not required for day-to-day operations, but it is used to control the rotation forces developed during pivoting, landing from a jump or side-stepping. An ACL injury is common while skiing or playing running ball sports. A person may feel to hear a snap or a crack. Swelling and knee pain shortly follows.

The ACL is surrounded by joint fluid, utilized unlike other ligaments about the joint. Other ligaments heal by scar formation, however, due to the unique location of the ACL, the bleeding is uncontained, filling the joints, causing pain and swelling. It can be a small tear for which rest or physical rehab would work well, but if the injury is severe, then ACL reconstruction is to be done.

These are the different types of grafts which are done for ACL reconstruction:

• Autograft: These grafts are taken out from the patient's body, portions include extensor mechanism, patellar tendon , hamstring tendon , semi-tendinousus tendon, iliotibial tract, menisci and gracilis tendon.
• Allograft: These grafts are taken from the corpses
• Xenograft: Grafts from the animals are taken in this type. A high rate of complications has been associated, particularly with bovine xenografts.
• Synthetics: This type can further sub-classified into 3 classes: carbon fibres , Gore-Tex and Dacron and devices for ligament augmentation.

Physical therapy before ACL surgery:

Physical therapy is often prescribed by the doctors for helping the patient which include:

• If there is any swelling on the knees it must be reduced
• The muscles around the knees must be strong if not exercise must be done to make them stronger.
• The motion range of knees must be normal if not restore it.

Nutrition before ACL surgery:

Caffeine, nicotine, and alcohol must be stopped before the ACL surgery. Nutrition must be included in the diet like multivitamins, vitamin c, zinc, as they all help in healing the wound post-surgery.

ACL reconstruction procedure uses a graft to replace the cruciate ligament. Autografts are the most common grafts which use part of your body, for example, hamstring tendons or patellar tendons or quadriceps muscles. Another form of the graft is allograft in which tissues from a deceased utilized. Arthroscopic surgery is used for an ACL reconstruction.

In this surgery, small incisions are done on the knee through which surgical instruments are inserted. Sometimes it is also done by making a large incision which is called an open knee surgery. Anesthesia would be given at first to immune your knee from feeling anything. During the procedure, an arthroscope is inserted through one of the small incisions. An arthroscope is a thin tube fitted with surgical instruments and a fibre-optic camera.

It helps the surgeon to get a view of the inside of the knee during the procedure. The torn ACL is first removed, and the area is cleaned. Small holes are drilled into the femur bone and the shin bone so that the bone plugs or anchor points to which the new tendons are outfitted, is attached with screws, posts or washers. After the new ligament is attached, the doctor would ensure that the graft is securely placed.

Finally, the wound would be stitched; the knee would be dressed and stabilized with a brace. The duration of the whole surgery would depend on the severity of the problem as well as the experience of the surgeon. Usually, a patient is discharged one or two days after the surgery.

The patient might feel numbness in or around the surgery area. It is rare, but the treatment can damage the nerves or other tissues in or around the knee if the surgery was not done properly. The screws that are attached to the bone can cause problems like loosening and might require removal.

If tissues of a deceased patient are used in the surgery, there remains a high risk of getting infected. Surgery needs to be carried out in a strict non-germ condition in an operation theatre. Despite these measures, there is a small percentage of chance of developing an infection in the joint.