TREATMENT - ACL Reconstruction Surgery and Aftercare

Arthroscopic ACL graft reconstruction surgery

Because the ACL has little to no capacity to heal itself, the ligament can only be reconstructed (replaced). It cannot be repaired (sewn back together).

There are many methods of reconstructing the ligament. Be sure to talk over each of these methods with your surgeon. Typically, a tendon from somewhere else in your knee or from a tissue bank (allograft) will be used to substitute for your old ACL. There are several choices for grafts including the patellar tendon, hamstring tendons, quadriceps tendon, achilles tendon, anterior tibilias tendon, and others. This tendon is fixed with a variety of methods including screws (either metal or plastic), buttons, pins, etc. The exact type of reconstruction will depend on your surgeon's preference based on his or her experience and success rates. Most surgeons nowadays will perform this reconstruction arthroscopically.

After surgery, there are several steps to your healing:

  1. Control Swelling

    First, you need to get your pain under control and decrease the swelling. Virtually every surgeon will recommend ice therapy of some kind. Some will prescribe a cryotherapy device. You may not have been prescribed a cryotherapy device because your insurance may not cover it; paying the hospital for the device can be VERY expensive. We have cryotherapy units that are identical to the ones handed out by many hospitals, but at a fraction of the cost (we do not have the overhead of your typical hospital!). The DonJoy IceMan is the state-of-the-art cryotherapy device used by hospitals and professional teams alike. It provides continuous, self-operating cooling to your joint. Our PolarCare Cub represents an intermediate cold therapy device which is functional in reducing pain and swelling, and economical in price. Unlike the Iceman, the Polarcare unit does not require electricity and can be taken anywhere, including the playing field. We also offer the DuraKold system, as well, for a more economical form of cryotherapy.

  2. Rehabilitate

    Second, you need to rehabilitate your knee. First you need to regain your motion, then your strength. This is usually done with the assistance of a physical therapist. However, in our experience, those people who perform exercises on their own, in addition to the 1-3 times a week prescribed physical therapy, will have superior results from their reconstruction.  In our own patients, it is easy to see who is doing their exercises at home and who is not. Those people who do home exercises clearly recover their range of motion and strength quicker, regain normal gait faster, and get back to non-pivoting sports (e.g., biking, running, swimming) sooner.

  3. Bracing

    Third, you need to discuss bracing with your doctor. This is usually broken down into to phases in the postoperative period: the immediate postop phase, and the rehabilitation phase. The immediate postop phase begins on the day of surgery and lasts for several weeks thereafter (the exact duration varies from surgeon to surgeon). Most doctors will give you a "range-of-motion" or "postoperative brace", such as the DonJoy IROM or DonJoy Telescoping TROM, immediately following surgery to protect your newly reconstructed graft. Important note: check with your insurance company before surgery about its coverage for braces! Many companies only reimburse a percentage of the brace. If you get the brace from a retail orthotic shop or the hospital at the time of surgery, it could cost you 2-3 times as much as the same exact brace bought from and taken with you to the hospital on the day of surgery! The DonJoy IROM is the most commonly presribed brace in the immediate rehab phase of surgery; most other braces are quite similar (but in our opinion, of lower quality). If you want to make sure the DonJoy IROM would be similar to another brace your surgeon has prescribed, please contact us.

    The second period is the rehabilitation phase. After your ligament has healed, your motion has been regained, and much of your strength improved, your surgeon may recommend a functional or "sports" brace. The decision will be based on your stability after reconstruction, the types of sports you want to return to, and you and your doctor's feelings about braces in general. This is a conversation you should have with your surgeon prior to your last visit with him or her. Remember, just because you've had your ACL reconstructed, it doesn't mean you can't still tear the ligament again the way you did the first time. We tell our patients that while ACL reconstruction is an excellent procedure to get them back to pre-injury level of sports, the reconstruction cannot make their knee better than it was originally. For that reason, most patients feel more comfortable wearing a sports brace for at least 1 season upon their return to play, while their strength, stability, and joint proprioception (nerve function) continue to improve.

A study (1) presented at the 2004 meeting of the American Orthopaedic Society for Sports Medicine showed that of professional skiers who have had ACL reconstructions, those who wore braces when they returned to sports were 2.74 times less likely to injure their knee than those who did not wear braces. This effect was even more pronounced in women: female skiers were 3.4 times more likely to injure their knee again if they did not wear a brace.

Your doctor may recommend a custom ACL brace. These are very expensive (more than $1,000) and many insurance companies will no longer cover them, especially after ACL reconstruction. We have found that the DonJoy eXtreme Armor Action and Ossur CTi OTS Pro Sport knee braces provides just as much stability, comfort, and function as any custom brace, at a fraction of the cost. The DonJoy eXtreme Armor Action utilizes DonJoy's patented 4-point stability system.

Another commonly prescribed knee brace is the DonJoy Legend. This is DonJoy's former top-of-the-line off the shelf knee brace. It provides excellent support, is lightweight and is breathable. It also utilizes the DonJoy 4-point stability system. It is a great brace and is less expensive than the DonJoy eXtreme Armor Action. However, it does lack the anti-migration supracondylar pads that helps to keep the eXtreme brace in place at your knee, and also is slightly heavier.

The next most commonly prescribed brace is a sturdy yet comfortable hinged knee brace. We, as well as many professional sports teams and the U.S. Ski team, favor the DonJoy Playmaker Knee Brace. This brace feels great, has a 4-point dynamic leverage system to specifically control movements that stress the ACL, and will allow you to return to contact sports, motocross racing, and skiing, to name a few. And, with our special online pricing, it is very affordable.

If you just need some mild side-to-side support and your knee is quite stable, then our Drytex Hinged Knee Brace, also made by DonJoy, is just the device for you. More economical than the Playmaker, it provides excellent stability for most non-contact activities and has even been used by many people with a stable knee after reconstruction for contact sports.

Please visit our knee solutions page to learn more about the equipment we have to offer for ACL tears.

1. "The role of functional bracing in preventing injury in ACL reconstructed professional skiers: A prospective cohort study". Farley TD, Sterett WI, et al. AOSSM Specialty Day Meeting, March 13, 2004, San Franciso, CA.

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