ACL surgery is a procedure to reconstruct the anterior cruciate ligament in the knee. It restores stability and function and allows patients to return to sports.
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Overview and Definition
Cruciate Surgery refers to surgical interventions performed to address injuries to the cruciate ligaments located inside the knee joint. The most commonly injured is the Anterior Cruciate Ligament (ACL), which runs diagonally in the middle of the knee. It prevents the tibia from sliding out in front of the femur and provides rotational stability to the knee. When this ligament is overstretched or torn, surgical intervention is often necessary for individuals who wish to return to an active lifestyle or sports.
The gold standard for treating a complete tear is Anterior cruciate ligament reconstruction. Because a torn ACL has a very poor blood supply, it typically cannot be simply stitched back together. Instead, the surgeon replaces the damaged ligament with a graft—a piece of healthy tendon from the patient’s own body (autograft) or from a donor (allograft). This procedure is performed arthroscopically, using small incisions and a camera to ensure precision while minimizing trauma to the surrounding knee structures.
In specific cases, anterior cruciate ligament repair surgery may be an option. Unlike a full reconstruction, a repair involves reattaching the torn ligament to the bone. This is generally only possible when the ligament has torn directly off the bone (avulsion) rather than shredding in the middle. At Liv Hospital, our orthopedic specialists utilize advanced diagnostic imaging to determine if a patient is a candidate for repair or if a full reconstruction is required to ensure long-term joint stability.
Injury and Causes
The need for Cruciate Surgery most often arises from sports-related trauma. Injuries to the Anterior Cruciate Ligament usually occur during activities that involve sudden stops, jumping, or changes in direction. Common mechanisms include planting the foot firmly and twisting the knee, or a direct blow to the side of the knee. These high-energy movements can put more stress on the ligament than it can handle, resulting in a partial or complete rupture.
When the ACL is injured, patients often report hearing or feeling a “loud pop” in the knee. This is immediately followed by significant swelling, a loss of range of motion, and a feeling of instability. Without a functioning Anterior Cruciate Ligament, the knee joint may “shift” painfully during movement. At Liv Hospital, we emphasize that an untreated tear can lead to secondary injuries, such as meniscus tears or the early onset of osteoarthritis due to abnormal joint wear.
Diagnosis and Imaging
Before proceeding with Cruciate Surgery, an orthopedic surgeon performs specific physical maneuvers, such as the Lachman test or the Pivot Shift test. These tests allow the doctor to feel the amount of “play” or looseness in the knee joint. If the tibia moves too far forward relative to the femur, it is a strong clinical indicator that the Anterior Cruciate Ligament has been compromised.
While X-rays are used to rule out bone fractures, an MRI is the essential tool for evaluating the ACL. An MRI provides a detailed view of the soft tissues, allowing the surgeon to see the exact location and severity of the tear. This imaging is also crucial for identifying “concomitant injuries,” such as bone bruises or meniscus tears, which frequently occur alongside an Anterior Cruciate Ligament injury and must be addressed during the surgical plan.
Treatment and Recovery
During Anterior cruciate ligament reconstruction, the surgeon removes the remnants of the torn ligament and drills small tunnels into the femur and tibia. The new graft is then pulled through these tunnels and secured with screws or other fixation devices. If the patient is a candidate for anterior cruciate ligament repair surgery, the original tissue is re-anchored to the bone. Both procedures aim to restore the “internal seatbelt” of the knee.
The recovery from Cruciate Surgery is a phased process that requires patience.
Rehabilitation Tips
The success of Cruciate Surgery is 50% the operation and 50% the rehabilitation. Because the new graft goes through a period of “revascularization” where it is temporarily weak, following your physical therapy protocol is essential. At Liv Hospital, we provide a structured, milestone-based program to guide you safely through each phase of recovery.
At Liv Hospital, we are specialists in Anterior cruciate ligament reconstruction and joint preservation. Our orthopedic surgeons utilize the latest minimally invasive techniques and advanced graft fixation to ensure the most stable results. We provide a comprehensive environment for healing, from high-definition diagnostic imaging to a dedicated sports rehabilitation center. Our goal is to help you return to your peak performance level safely and effectively. We encourage you to reach out and call Liv Hospital to schedule a consultation and begin your journey back to an active life.
Send us all your questions or requests, and our expert team will assist you.
It is called “anterior” because it attaches to the front (anterior) part of the tibia. “Cruciate” comes from the Latin word for cross, because the ACL and PCL cross each other inside the knee joint.
Yes, cruciate surgery is typically performed under general anesthesia. This ensures the muscles are completely relaxed, which is necessary for the surgeon to manipulate the knee and visualize the joint space accurately.
A repair involves sewing the torn ligament back together, which is only possible in very specific types of tears (like avulsions). Reconstruction involves removing the damaged tissue and replacing it with a new graft, which is the standard treatment for mid substance tears.
Yes, the screws or buttons used to fix the graft into the bone tunnels are generally designed to stay in the knee permanently. They are made of titanium or bioabsorbable materials. They are only removed if they cause irritation or infection, which is rare.
Yes, many people live without an ACL, especially if they have low physical demands. However, without an ACL, the knee is unstable during pivoting movements. This instability can lead to further damage to the meniscus and cartilage, increasing the risk of arthritis.
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