ACL Reconstruction and Meniscus Repair Surgery (2023)

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ACL Reconstruction and Meniscus Repair Surgery (1)

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What is ACL Reconstruction?

The ACL, or anterior cruciate ligament, is a structure within the knee that helps to control movement androtationof the knee joint. It is one of the most common knee ligaments that can be injured and may be torn during a sudden, twisting movement of the knee.

(Video) Sarah: ACL Reconstruction and Meniscus Repair

In ACL reconstruction, the torn ligament is removed and replaced with a piece of tendon from another part of your knee or from a deceased donor. This surgery is an outpatient procedure that is performed through small incisions around your knee joint. Many orthopaedic surgeons prefer to use arthroscopic surgery rather than open surgery for ACL injuries because:

  • It is easy to see and to work on the knee structures.
  • Smaller incisions are required.
  • It has fewer risks than open surgery.

Why is ACL Reconstruction done?

The goal before surgery is to reduce pain and swelling, to restore your knee’s full range of motion, and strengthen muscles. Not all ACL tear require surgery. Your physician will decide whether only rehabilitation or surgery plus rehabilitation is right for you.

You may choose to have surgery if you:

  • Have a completely torn ACL and your knee is very unstable.
  • Have gone through rehabilitation and your knee is still unstable.
  • Are very active in sports or have a job requiring knee strength and stability (such as construction work), and you want your knee to be just as strong and stable as it was before your injury.
  • Have chronic ACL deficiency, that is when your knee is unstable and affecting the quality of your life.

How is ACL reconstruction performed?

Before your surgery, you will have to undergo several weeks of physical therapy. ACL reconstruction is performed with general anaesthesia and it is an outpatient procedure, so you will be able to go home on the same day.

Step 1 – ACL reconstruction is usually done through small incisions. One to hold a thin, tube-like video camera (arthroscope) and others are to allow surgical instruments access to the joint space.

Step 2 – Your surgeon will remove your damaged ligament, and replace it with a segment of tendon, which is called a graft. This can be an autograft (using a tendon from your own knee) or an allograft (using a donor tendon).

Step 3 – Your surgeon will drill sockets or tunnels into your thighbone and shinbone to position the graft accurately, which is then secured to your bones with screws and other fixation devices. The graft will serve as a scaffolding on which new ligament tissue can grow.

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What Happens After ACL Reconstruction?

  • Once you recover from the anaesthesia, you can go home on the same day. But before you are discharged, you will need to practice walking with crutches, and your surgeon may ask you to wear a knee brace or splint to help you protect the graft.

  • Your doctor will give you specific instructions on how to control swelling and pain after the surgery. It is important to keep your leg elevated, apply ice to your knee and rest as much as possible.

  • After surgery, physical therapy will help you regain your range of motion and strengthen the muscle which supports the joint and improves flexibility. A physical therapist will teach you how to do exercises that you will perform under his supervision or continue the same at home.

What is the outcome and recovery of ACL Reconstruction?

  • Successful ACL reconstruction along with focused rehabilitation can restore stability and function to your knee.
  • Within the first few weeks after surgery, you should strive to regain a range of motion equal to your opposite knee.
  • In general, recovery takes about nine months. It can take 8 to 12 months approximately for athletes to return to their sports.

What is the Role of a Meniscus in a Knee Joint?

The meniscus is a crescent-shaped disc of cartilage which is between your femur (thighbone) and tibia (shinbone). There are two menisci in each knee joint. The meniscus is like a shock absorber that helps to stabilize the knee by balancing your weight across the knee. It also provides protection of healthy cartilage in the knee joint.

What is a Meniscus Tear in a Knee Joint?

Each of your knees has a two C-shaped pieces of cartilage that act like a cushion between your shinbone and thighbone (menisci). A meniscus tear causes pain, swelling and stiffness. You also might feel an obstruction to knee motion and have trouble extending your knee fully. A meniscus tear can lead to an inability to move your knee normally or persistent knee pain. You may be more likely to develop osteoarthritis in the injured knee.

What are the Causes of a Meniscus Tear?

  • Any activity causing you to forcefully twist or rotate your knee, especially when putting your full weight on it, or by lifting something heavy can lead to a meniscus tear.

    (Video) ACL Reconstruction Surgery and Meniscus Repair - Madeleine's Story | Temple Health

  • The meniscus weakens with age and meniscus tears have become more common in people over the age of 30. If you have osteoarthritis, you are at a higher risk of injuring your knee or tearing your meniscus. Osteoarthritis is a common joint disorder involving pain and stiffness in your joints which is caused by aging and wear and tear.

  • When an older person experiences a meniscus tear, it is related to degeneration. This is when the cartilage in the knee becomes weaker and thinner and as a result, it is more prone to tear.

What are the Symptoms of Meniscus Tear?

When a meniscus tear occurs, you may hear a popping sound around your knee joint and you may experience the following:

  • Pain when the area is touched
  • swelling or stiffness
  • difficulty moving your knee in a full range of motion
  • Your knee will be locking or catching.
  • your knee will be unstable

What is the Treatment for a Meniscus Tear?

If the tear is small and is on the outer edge of the meniscus, patient may not require a surgical repair. As long as the symptoms like excessive pain, swelling, inability of knee movements, cracking sound does not persist then your knee is stable and nonsurgical treatment can be advisable. Initially, you should treat the knee injury with conservative techniques which include rest, ice, compression, and elevation, or the RICE method:

  • Rest your knee:Use crutches to avoid any weight on the joint. Avoid any activities that can worsen your knee pain.
  • Iceyour knee every three to four hours.
  • Compressthe knee in an elastic bandage to reduce inflammation.
  • Elevateyour knee to reduce swelling.

If symptoms persist with nonsurgical treatment, then you should go for Meniscus Repair surgery.

What are the Types of Meniscus Repair Surgery?

Meniscus Repair Surgery is a procedure to repair torn knee cartilage. There are surgical and non-surgical treatments for Meniscus repair depending upon the case. Depending upon the intensity of the tear, which can be mild (grade1, 2) or severe (grade 3), your surgeon will choose the following procedure based on your condition:

  • Arthroscopic repair –In this procedure, the surgeon makes small cuts in knee and then insertsanarthroscopeto have a clear view of the tear. Then a small device is placed thatseem like adartonthe tear tosewit up and then the body will absorb these over time.
  • Arthroscopic partial meniscectomy –In this procedure the surgeon will remove a piece of the torn meniscus so the patient’s knee can function normally.
  • Arthroscopic total meniscectomy –In this procedure, the surgeon will remove the whole meniscus.

How is the Meniscus Tear Surgery Performed?

This surgical procedure usually lasts for an hour.

  • Partial Meniscectomy – Accordingly, surgical instruments are used to trim or repair the meniscus.
  • Meniscus Repair – In this procedure, the broken cartilage tissue is removed.

Step 1 – Our specialists perform meniscus tear surgery arthroscopically, by making small cuts in the knee. The surgeon inserts an arthroscope through a small incision (portal) to see the kind of repair. This provides a transparent view of the knee.

Step 2 – When the surgeon locates the problem in your knee, he may insert small tools into the incisions to repair or trim the damaged meniscus. However, some cartilage tears may be repaired by sewing (stitching) the torn parts.

What is the outcome and recovery for Meniscus Tear Surgery?

In some cases the recovery frommeniscussurgery is measured by days to weeks, and in cases of a meniscus repair it can take few months to recover fully.

  • The recovery totally depends on whether you had a meniscus repair (sutures) or if simply had the torn pieces removed (partial menisectomy). The Cartilage in a knee joint does not have a significant blood supply, which can affect its ability to heal. However, there are some areas of the meniscus, such as the outer portions, which have more blood vessels and are more likely to heal.

  • You should use an ice pack on your knee and a dressing and keep your leg elevated for a day or two. The ice will help to reduce swelling and reduce your pain.

  • You can participate in physical therapy within a few days after surgery. If your procedure involves a meniscal repair, then the recovery and rehabilitation time is about six weeks. You will wear a knee brace or crutches during this time. Rehabilitation exercises will help to regain range of motion and strengthen the muscles that support the joint.

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(Video) ACL with Lateral Meniscus - Andrews Sports Medicine & Orthopaedic Center
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(Video) ACL Reconstruction Surgery & Medial Meniscus Repair - Dr. David Mack

Frequently asked Questions:

How successful is ACL reconstruction?

ACL reconstruction has been a successful operation, with satisfactory outcomes in 75% to 97% of patients (4, 5). However, with the number of primary procedures being performed increasing each year, the absolute number of graft failures after ACL repair is also rising.

How many years does an ACL repair last?

Reconstruction patients even 20 years later revealed excellent performance, with over 85% still active. However, over 40% revealed some degree of osteoarthritis.

How long do I have to wear my knee brace after ACL surgery?

You must wear the hinged-knee brace for the first 6 weeks. This brace protects the meniscus repair because it prevents you from bending the knee more than 90 degree.

What is the strongest ACL graft?

Patella Tendon Autograft – It has a stronger fixation because of the bone plugs that can incorporate into the femoral and tibial tunnels by 6-8 weeks after surgery.

How is a meniscus tear diagnosed?

A meniscus injury can be diagnosed by an X-ray and it can help the doctor rule out other causes of knee pain, such as a fracture or arthritis. To properly visualize the meniscus and adjacent cartilage, an MRI scan may be indicated for some patients.

How long do you have to wear a knee brace after meniscus surgery?

You must wear the hinged – knee brace for the first 6 weeks. This brace protects the meniscus repair because it can prevent you from bending the knee past 90 degrees.

Is a torn meniscus a permanent injury?

Patients with a torn meniscus often complain of locking, catching, popping, or sticking in the knee. Left unattended, a meniscus injury can linger for years, causing ongoing pain and limited mobility. If a meniscus tear is not repaired, you risk further injury and permanent damage to your knee.

What happens if you do not repair a meniscus tear?

(Video) ACL Reconstruction and Meniscus Repair: Surgery Day

If untreated, part of the meniscus may become loose and slip into the joint. You may need surgery to restore the knee function. Untreated meniscus tears can increase in size and may lead to complications, such as arthritis.


How long does it take to recover from ACL and meniscus surgery? ›

Total recovery time for an ACL reconstruction with meniscus repair is 12-16 weeks, and it varies with each individual. Patients may drive after pain medication, but when the right knee is affected, the patient must wait for 4-6 weeks before resuming driving.

When can I walk after ACL reconstruction and meniscus repair? ›

Patients walk unassisted within 2-4 weeks, but for short periods. After 10-12 weeks, expect brisk walking, light jogging, and even plyometric exercise. Full recovery on ACL reconstruction is 6-12 months, or more with physical therapy.

Can you have ACL and meniscus surgery at the same time? ›

Because the procedure utilizes smaller incisions, patients often have less scarring and less pain after surgery. The procedure varies based on whether the tear is in the meniscus, the ACL, or both. If both the ACL and the meniscus are torn, Dr. Casey will typically do both procedures at the same time.

How long after ACL and meniscus surgery can I bend my knee? ›

Patients will be in a hinged knee brace for 4 weeks post-op locked in full extension. No active knee flexion X 4 weeks. Partial / toe-touch weight bearing for 3-5 days post-op, increasing to full weight bearing--important to watch for lower leg rotation or “heel whip” with ambulation to avoid stress onto the meniscus.

Is ACL and meniscus surgery painful? ›

Most people have some surgery-related pain and discomfort for the first week or so. Not surprisingly, pain decreases with time. By the end of a week or two at the most, you should have very little discomfort. Swelling and bruising are also relatively common, and like discomfort, they're temporary.

Can you weight bear after ACL and meniscus surgery? ›

You must be non-‐weight bearing with brace and crutches until cleared by your surgeon. When you are using crutches your brace must be locked in extension. You must wear the hinged-‐knee brace for the first 6 weeks. This brace protects the meniscus repair because it prevents you from bending the knee past 90 degrees.

Is it worse to tear ACL or meniscus? ›

Injuries to the meniscus, whether or not they require surgical treatment, will generally take about three months to resolve. “In some cases, it may even be quicker,” Dr. Lederman said. ACL injuries tend to take more time.

Do I have to sleep with my brace on after ACL and meniscus surgery? ›

You need to sleep with your brace locked in extension for the first two weeks. You will discontinue the brace once you have full ROM and good quadriceps control. This usually occurs between 4 and 6 weeks post-op.

How much bed rest is required after ACL surgery? ›

Rest: 0 to 2 weeks after ACL surgery

For the first couple of weeks after surgery, you will need to rest and care for the incision site. Prop your leg — at the calf or ankle — on a couple of pillows four to six times a day.

Can you bend your leg after ACL and meniscus surgery? ›

It is very safe to bend the knee and the physiotherapist will have you onto the CPM machine day one after surgery. The bending won't come back without some gentle pushing on your part. Start with the drop and dangle exercise in my rehabilitation program. Some people are apprehensive about damaging their reconstruction.

How do you sit on the toilet after ACL surgery? ›

On and off toilet - YouTube

What happens 1 week after ACL surgery? ›

The First Two Weeks After ACL Surgery

The first couple of weeks after surgery can be the most challenging. It's when you are likely to experience the most pain. However, ACL surgery recovery pain is manageable. Icing and elevating your knee can help reduce your pain, and your doctor will also prescribe pain medicine.

Is walking good after ACL and meniscus surgery? ›

After ACL surgery it is important to aim towards walking normally and improving your gait. Within the initial few weeks after your ACL reconstruction surgery, try to gradually improve your walking each day: Start by using two crutches post surgery and take as much weight as you feel is comfortable.

How long after ACL surgery can you go for a walk? ›

It's important to start walking within a day or two after ACL surgery, but only a little. Walking for a minute or two can help reduce swelling, but you shouldn't walk any more than that. After two weeks, you can start walking around unassisted without crutches for short periods of time.

How long after ACL surgery can you walk normally? ›

By the end of the second or third week, patients usually walk without crutches. Sessions with a physical therapist usually begin seven to 14 days after surgery. During physical therapy, weight bearing is allowed if you did not have a meniscus repair.

How much bed rest is required after ACL surgery? ›

Rest: 0 to 2 weeks after ACL surgery

For the first couple of weeks after surgery, you will need to rest and care for the incision site. Prop your leg — at the calf or ankle — on a couple of pillows four to six times a day.

When can I drive car after ACL surgery? ›

When can you start driving after ACL surgery? You are not fit to drive until six weeks, with the exception that if you had a left knee ACL reconstruction, you can drive an automatic after three weeks. You need to be able to stand on 1 leg for 1 minute to be fit to drive.

How many hours does ACL surgery take? ›

The procedure usually takes less than two hours. It will require an incision to remove a tendon if you are undergoing an autograft, in which a tendon from another part of your body is inserted in your knee.

Can I climb stairs after ACL surgery? ›

It should take about a month to be able to climb stairs comfortably following surgery. Most patients have returned to a normal daily return with no pain or swelling after the first month (and often sooner).

Do and don'ts after ACL reconstruction? ›

The Do's and Don'ts After ACL Surgery
  • Do: Keep your knee straight! ...
  • Don't: Put weight on your new knee. ...
  • Do: Wear your knee brace! ...
  • Don't: Walk, swim, cycle, bend and extend your knee, etc. ...
  • Do: Physical therapy. ...
  • Do: Go to your scheduled follow-ups with your knee surgeon.

How long do you need crutches after ACL surgery? ›

Without crutches & brace:

– It's common to be restricted to walking with brace locked in extension, crutches and partial weight bearing for 6 weeks following surgery. – Or you may get the okay from your surgeon between 2-4 weeks, to unlock the brace from 0-90° of knee bend (flexion) but maintain use of crutches.


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