ACL Video

About ACL Reconstruction

The sports medicine doctors at the University Orthopaedic Center have a long history of working with ACL injuries. The ACL (anterior cruciate ligament) is one of four ligaments that are crucial to knee stability. This strong fibrous tissue is part of a complicated network of tendons and ligaments that help stabilize and support the knee. This region is particularly vulnerable to injury during athletic activity or as the result of impact.

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ACL Protection & Prevention Program

Ligament Injuries to the Knee

What are knee ligaments?

There are 4 major ligaments in the knee. Ligaments are elastic bands of tissue that connect bones to each other and provide stability and strength to the joint. The four main ligaments in the knee connect the femur (thighbone) to the tibia (shin bone), and include the following:

  • Anterior cruciate ligament (ACL). The ligament, located in the center of the knee, that controls rotation and forward movement of the tibia (shin bone).

  • Posterior cruciate ligament (PCL). The ligament, located in the back of the knee, that controls backward movement of the tibia (shin bone).

  • Medial collateral ligament (MCL). The ligament that gives stability to the inner knee.

  • Lateral collateral ligament (LCL). The ligament that gives stability to the outer knee.

How are cruciate ligaments injured?

The anterior cruciate ligament (ACL) is one of the most common ligaments to be injured. The ACL is often stretched and/or torn during a sudden twisting motion (when the feet stay planted one way, but the knees turn the other way). Skiing, basketball, and football are sports that have a higher risk of ACL injuries.

The posterior cruciate ligament (PCL) is also a common ligament to become injured in the knee. However, the PCL injury usually occurs with sudden, direct impact, such as in a car accident or during a football tackle.

What are the symptoms of a cruciate ligament injury?

Often, a cruciate ligament injury does not cause pain. Instead, the person may hear a popping sound as the injury occurs, followed by the leg buckling when trying to stand on it, and swelling. However, each individual may experience symptoms differently.

The symptoms of a cruciate ligament injury may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How are collateral ligaments injured?

The medial collateral ligament is injured more often than the lateral collateral ligament. Stretch and tear injuries to the collateral ligaments are usually caused by a blow to the outer side of the knee, such as when playing hockey or football.

What are the symptoms of a collateral ligament injury?

Similar to cruciate ligament injuries, an injury to the collateral ligament causes the knee to pop and buckle, causing pain and swelling.

The symptoms of a collateral ligament injury may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How is a knee ligament injury diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for a knee ligament injury may include the following:

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film to rule out an injury to bone instead of, or in addition to, a ligament injury.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in bones and a surrounding ligament or muscle.

  • Arthroscopy. A minimally-invasive diagnostic and treatment procedure used for conditions of a joint. This procedure uses a small, lighted, optic tube (arthroscope) that is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen; used to evaluate any degenerative and/or arthritic changes in the joint; to detect bone diseases and tumors; to determine the cause of bone pain and inflammation.

Treatment for knee ligament injuries

Specific treatment for a knee ligament injury will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the injury

  • Your tolerance for specific medications, procedures, and therapies

  • Expectation for the course of the injury

  • Your opinion or preference

Treatment may include:

  • Medication such as ibuprofen

  • Muscle-strengthening exercises

  • Protective knee brace (for use during exercise)

  • Ice pack application (to reduce swelling)

  • Surgery

Knee Ligament Repair

(ACL Repair, ACL Reconstruction, PCL Repair, PCL Reconstruction, MCL Repair, MCL Reconstruction, LCL Repair, LCL Reconstruction)

Procedure overview

What is knee ligament repair?

Ligaments are bands of tough, elastic connective tissue that surround a joint to give support and limit the joint's movement. When ligaments are damaged, the knee joint may become unstable. The ligament damage often occurs from a sports injury. A torn ligament severely limits knee movement, resulting in a person’s inability to pivot, turn, or twist their leg. Those individuals who cannot return to normal activities with medical treatments for a torn ligament may have the ligament repaired or reconstructed (replacing the ligament) with surgery.

Anatomy of the knee

Joints are formed where bones meet. Most joints are mobile, allowing the bones to move. Basically, the knee is 2 long leg bones held together by muscles, ligaments, and tendons. Each bone end is covered with a layer of cartilage that absorbs shock and protects the knee.

There are 2 groups of muscles involved in the knee, including the quadriceps muscles (located on the front of the thighs), which straighten the legs, and the hamstring muscles (located on the back of the thighs), which bend the leg at the knee.

Tendons are tough cords of tissue that connect muscles to bones. Ligaments are elastic bands of tissue that connect bone to bone. Some ligaments of the knee provide stability and protection of the joints, while other ligaments limit forward and backward movement of the tibia (shin bone).

The knee consists of the following:

  • Tibia. This is the shin bone or larger bone of the lower leg.

  • Femur. This is the thighbone or upper leg bone.

  • Patella. This is the kneecap.

  • Cartilage. A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint.

  • Synovial membrane. A tissue that lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.

  • Ligament. A type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint's movement.

  • Tendon. A type of tough connective tissue that connects muscles to bones and helps to control movement of the joint.

  • Meniscus. A curved part of cartilage in the knees and other joints that acts as a shock absorber.

What are the ligaments of the knee?

There are 4 major ligaments in the knee. The ligaments in the knee connect the femur (thighbone) to the tibia (shin bone), and include the following:

  • Anterior cruciate ligament (ACL). The ligament, located in the center of the knee, that controls rotation and forward movement of the tibia (shin bone).

  • Posterior cruciate ligament (PCL). The ligament, located in the center of the knee, that controls backward movement of the tibia (shin bone).

  • Medial collateral ligament (MCL). The ligament that gives stability to the inner knee.

  • Lateral collateral ligament (LCL). The ligament that gives stability to the outer knee.

Reasons for the procedure

The anterior cruciate ligament (ACL) is located toward the front of the knee. It is the most common ligament to be injured. The ACL is often stretched and/or torn during a sudden twisting motion (when the feet stay planted one way, but the knees turn the other way). Skiing, basketball, and football are sports that have a higher risk of ACL injuries.

The posterior cruciate ligament (PCL) is located toward the back of the knee. It is also a common knee ligament to be injured. However, the PCL injury usually occurs with sudden, direct impact, such as in a car accident or during a football tackle.

The medial collateral ligament (MCL) is located on the inner side of the knee. It is injured more often than the lateral collateral ligament (LCL), which is on the outer side of the knee. Stretch and tear injuries to the collateral ligaments are usually caused by a blow to the outer side of the knee, such as when playing hockey or football.

Early medical treatment for knee ligament injury may include, but is not limited to, the following:

  • Rest

  • Ice pack application (to reduce swelling that occurs within hours of the injury)

  • Compression (from an elastic bandage or brace)

  • Elevation

  • Pain relievers

A knee ligament tear may be treated with the following:

  • Muscle-strengthening exercises

  • Protective knee brace (for use during exercise)

  • Activity limitations

Knee ligament repair or reconstruction is a treatment for a complete tear of a knee ligament that results in instability in the knee. People with a torn knee ligament may be unable to do normal activities that involve twisting or turning at the knee. The knee may buckle or "give-way." If medical treatments are not satisfactory, ligament repair or reconstruction surgery may be an effective treatment.

The surgery to correct a torn knee ligament involves replacing the ligament with a piece of healthy tendon. A tendon from the kneecap or hamstring, for example, is grafted into place to hold the knee joint together. The tendon graft may come from the person (autograft) or from an organ donor (allograft).

There may be other reasons for your doctor to recommend a knee ligament repair or reconstruction.

Risks of the procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

  • Bleeding

  • Infection

  • Blood clots in the legs or lungs

  • Continued knee laxity or stiffness 

Some individuals experience pain, limited range of motion in the knee joint, and occasional swelling in the knee after surgical ligament repair. Others have increased motion in the knee joint as the graft stretches over time.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

  • Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

  • In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.

  • Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

  • Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.

  • Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

  • If you are pregnant or suspect that you are pregnant, you should notify your doctor.

  • You will be asked to fast for eight hours before the procedure, generally after midnight.

  • You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for some to drive you home.

  • You may meet with a physical therapist prior to your surgery to discuss rehabilitation.

  • Arrange for someone to help around the house for a week or two after you are discharged from the hospital.

  • Based on your medical condition, your doctor may request other specific preparation.

During the procedure

Knee ligament repair or reconstruction surgery may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.

Knee ligament repair or reconstruction surgery may be performed while you are asleep under general anesthesia, or while you are awake under spinal anesthesia. If spinal anesthesia is used, you will have no feeling from your waist down. Your doctor will discuss this with you in advance.

Generally, knee ligament repair or reconstruction surgery follows this process:

  1. You will be asked to remove clothing and will be given a gown to wear.

  2. An intravenous (IV) line may be started in your arm or hand.

  3. You will be positioned on the operating table.

  4. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

  5. The skin over the surgical site will be cleansed with an antiseptic solution.

  6. The doctor will make several small incisions in the knee area.

  7. The doctor will perform the surgery using an arthroscope (a small tube-shaped instrument that is inserted into a joint). The doctor may reattach the torn ligament or reconstruct the torn ligament by using a portion (graft) of the patellar tendon (that connects the kneecap to the tibia), the hamstring tendon (from the back of the thigh), or other autografts. The tendon graft may come from the person (autograft) or from an organ donor (allograft).

  8. The doctor will drill small holes in the tibia and femur where the torn ligament was attached.

  9. The doctor will thread the graft through the holes and attach it with surgical staples or screws. Bone eventually grows around the graft.

  10. The incision will be closed with stitches or surgical staples.

  11. A sterile bandage or dressing will be applied.

After the procedure

After the surgery you will be taken to the recovery room for observation. Your recovery process will vary depending on the type of anesthesia that is given. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. Knee ligament repair is usually done on an outpatient basis.

You may be given crutches and a knee immobilizer before you go home.

Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.

Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

To help reduce swelling, you may be asked to elevate your leg and apply an ice bag to the knee several times per day for the first few days. Your doctor will arrange for an exercise program to help you regain muscle strength, stability, and range of motion.

Notify your doctor to report any of the following:

  • Fever

  • Redness, swelling, bleeding, or other drainage from the incision site

  • Increased pain around the incision site

You may resume your normal diet unless your doctor advises you differently.

Because of the limited mobility, it may be difficult for a few weeks to resume your normal daily activities. You may need someone at home to assist you. You should not drive until your doctor tells you to. Other activity restrictions may apply. Full recovery from the surgery and rehabilitation may take several months.

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.

This page contains links to other websites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these websites, nor do these sites endorse the information contained here.

American Academy of Orthopaedic Surgeons

American College of Rheumatology

Arthritis Foundation

National Institute of Child Health and Human Development

National Institutes of Health (NIH)

National Library of Medicine

Stephen K. Aoki, M.D.

Dr. Stephen K. Aoki, Assistant Professor, specializes in hip and knee sports medicine. His clinical practice and research focus on both adult and pediatric sports injuries. Current interests include hip preservation in the young adult, hip arthroscopy, the pediatric and adolescent athlete, ACL tears in children,... Read More

Specialties:

ACL Reconstruction, Femoroacetabular Impingement, Hip Arthroscopy, Hip Preservation, Knee, Knee Preservation, Labral Tear, Minimally Invasive Joint Surgery, Orthopaedic Surgery, Pediatric Orthopaedic Surgery, Sports Medicine

Locations:

Pediatric Orthopaedics (801) 662-5600
University Orthopaedic Center (801) 587-7109

Robert T. Burks, M.D.

Dr. Robert Burks, Professor, specializing in the field of sports medicine and shoulder surgery. His practice focuses on injuries to and degenerative conditions of the shoulder and knee. Dr. Burks graduated from St. Louis University School of Medicine in 1978. He completed his orthopedic residency at the Universi... Read More

Specialties:

ACL Reconstruction, Knee, Orthopaedic Surgery, Shoulder, Sports Medicine

Locations:

University Orthopaedic Center (801) 587-7109

Patrick E. Greis, M.D.

Dr. Patrick Greis, Board Certified Professor of Orthopaedic Surgery, joined the Department of Orthopaedics in March of 1997 and specializes in sports medicine, knee and shoulder surgery. His interests include all aspects of knee and shoulder surgery, including arthroscopic surgery, ACL reconstruction, shoulder i... Read More

Specialties:

ACL Reconstruction, Knee, Orthopaedic Surgery, Shoulder, Sports Medicine

Locations:

University Orthopaedic Center (801) 587-7109

Emily J. Harold, M.D.

Emily Harold, MD, is a board-certified physician specializing in sports medicine. She received her bachelor's degree from Washington University, where she also played basketball and contributed to three National Championship teams. Dr. Harold received her medical degree from Ohio State University, and went on to... Read More

Specialties:

Foot and Ankle, Internal Medicine, General, Sports Medicine

Locations:

Redwood Health Center (801) 213-8841
University Orthopaedic Center (801) 587-7109

Richard W. Kendall, D.O.

Dr. Richard W. Kendall holds board certifications from The American Board of Physical Medicine and Rehabilitation with a sub-specialty certification in pain management. Dr. Kendall's focus is on rehabilitation treatments and diagnosis of back and neck pain using interventional spine procedures, electrodiagnosit... Read More

Specialties:

Back, EMG, Electrodiagnosis, Neck, Non-operative Musculoskeletal Disorders, Osteopathic Care, Physical Medicine & Rehabilitation, Spine, Spine Evaluation, Sports Medicine

Locations:

University Orthopaedic Center (801) 587-7109

Travis G. Maak, M.D.

Dr. Travis Maak’s practice is focused on sports medicine and arthroscopic treatment of the knee, hip, and shoulder. Dr. Maak is originally from Salt Lake City and a graduate from Stanford University. He completed his medical school at Yale School of Medicine and surgical internship at New York Presbyterian Hosp... Read More

Specialties:

ACL Reconstruction, Cartilage Restoration, Femoroacetabular Impingement, Hip Arthroscopy, Hip Preservation, Minimally Invasive Joint Surgery, Orthopaedic Surgery, Pediatric Orthopaedic Surgery, Sports Medicine

Locations:

Primary Children's Hospital (801) 662-5600
South Jordan Health Center (801) 213-4500
University Orthopaedic Center (801) 587-7109

David J. Petron, M.D.

Dr. David Petron, Assistant Professor (clinical) is a primary care orthopaedic/sports medicine specialist. He originally trained in family practice and then completed a fellowship in primary care orthopaedics and sports medicine at Michigan State University. Dr. Petron is the Director of Primary Care Sports Medi... Read More

Specialties:

Family Medicine, Foot and Ankle, Shoulder, Spine Evaluation, Sports Medicine

Locations:

UUHC - Park City Ski Clinic (435) 655-7970
University Orthopaedic Center (801) 587-7109

Amy P. Powell, M.D.

Dr. Amy Powell, Assistant Professor, (clinical) is a board certified Sports Medicine physician serving as a team physician for the University of Utah Utes. She specializes in the care of athletes and active people of all ages, focusing on attaining and maintaining a patient’s physical performance goals. Dr. Powe... Read More

Specialties:

Foot and Ankle, Shoulder, Sports Medicine

Locations:

University Orthopaedic Center (801) 587-7109

Pamela A. Hansen, M.D.

Dr. Pamela A. Hansen is board certified in Physical Medicine and Rehabilitation and Sports Medicine, specializing in musculoskeletal sports and spine rehabilitation. Dr. Hansen's clinical interests include rehabilitation of musculoskeletal problems, interventional spine procedures, and electrodiagnostic testing.... Read More

Specialties:

Acupuncture, Back, Cancer Rehabilitation, EMG, Electrodiagnosis, Foot and Ankle, Neck, Non-operative Musculoskeletal Disorders, Physical Medicine & Rehabilitation, Spine, Spine Evaluation, Sports Medicine

Locations:

Huntsman Cancer Institute (801) 587-4585
University Orthopaedic Center (801) 587-7109

Stuart E. Willick, M.D.

Stuart Willick, M.D. is a fellowship trained, board certified sports medicine physician. He has worked with numerous elite sports organizations, including the University of Utah, United States Ski and Snowboard Association, US Speedskating, US Bobsled and Skeleton Federation, and the International Olympic and P... Read More

Specialties:

Spine, Sports Medicine

Locations:

Redstone Health Center (435) 658-9262
University Orthopaedic Center (801) 587-7109
University Orthopaedic Center 590 Wakara Way
Salt Lake City, UT 84108
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801-587-7109
South Jordan Health Center 5126 W. Daybreak Parkway
South Jordan, UT 84095
Map
801-213-4500
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