What Is ACL Reconstruction?
The ACL runs through the middle of the knee and connects the thighbone to the shinbone. It keeps the shinbone from sliding forward and helps control twisting. A torn ACL does not heal well on its own, so surgery replaces it rather than stitching it back together.
The surgery is done arthroscopically, meaning through small incisions with a camera. The surgeon removes the torn ligament, drills small tunnels or sockets in the thighbone and shinbone, and fixes a graft in place. The graft is often your own tendon (an autograft), taken from the quadriceps, patellar tendon or hamstrings, or it can be donor tissue (an allograft).
Dr. Wolfson, who is fellowship-trained in sports medicine and arthroscopy at the University of Miami, uses an all-inside quadriceps tendon technique for ACL reconstruction. Dr. Chalal, who has practiced sports medicine in Palm Beach since 1988, also performs ACL surgery. Your surgeon will explain which graft they recommend and why.
Performed as an outpatient procedure at a hospital or surgery center where our surgeons operate, with evaluation, imaging and physical therapy here in our Boynton Beach office.
Who Is a Candidate?
ACL reconstruction is often recommended if you play sports that involve cutting, pivoting or jumping, if your knee keeps giving way during everyday activity, or if you have other injuries such as a repairable meniscus tear. Some people who are less active and do not have instability can do well with physical therapy and activity changes alone.
Before surgery, it helps to get swelling down and motion back. Our on-site physical therapists often start this "prehab" soon after the injury.
What to Expect
Your evaluation includes a hands-on exam and imaging in our office, usually an X-ray and an MRI. Surgery is typically outpatient, so most people go home the same day. It usually takes about one to two hours under general or regional anesthesia. You will go home in a brace or with crutches, depending on your surgeon's plan and any other repairs done at the same time.
Risks and Side Effects
Risks include infection, blood clots, stiffness, knee pain at the front of the knee or where the graft was taken, numbness near the incision, graft failure or re-tear, and anesthesia risks. Following your rehab plan and returning to sport only after you pass strength and function testing are important ways to lower the risk of re-injury.
Recovery
ACL recovery takes time. Physical therapy usually starts within the first week. Many people walk without crutches within a few weeks and return to light jogging around three to four months. Return to cutting and pivoting sports is commonly around nine to twelve months, based on strength and functional testing rather than the calendar alone. Timelines vary.
Because our physical therapists share your chart with your surgeon, return-to-sport decisions are made together.
Physical therapy happens in our office, with therapists who share your chart. Learn about on-site physical therapy.
Insurance and Cost
ACL reconstruction is usually covered by most commercial PPO plans and Medicare when it is medically necessary, often with prior authorization. HMO and managed-care plans need a referral from your primary care physician before the visit. Co-pays, co-insurance and deductibles apply. If you were injured on the job, we accept workers' compensation and coordinate paperwork with your employer and carrier. Call our office to verify your benefits.
When to Talk to a Specialist
Schedule a visit if you felt a pop in your knee during a twist or landing, the knee swelled within hours, or it now feels unstable. Go to the emergency room or call 911 if the knee looks deformed, you cannot bear weight, or after surgery you have fever, spreading redness or drainage. Call our office the same day about new calf pain or swelling after surgery; if you cannot reach us, go to the emergency room. Call 911 for sudden shortness of breath or chest pain.
