Nonsurgical treatment may be a reasonable option when these conditions are not met. Nonsurgical treatment may be a good option for elderly people with a low activity level. Ask your doctor about all of your treatment options and consider getting a second opinion before having ACL surgery.

Who performs anterior cruciate ligament (ACL) surgery?

An orthopedic surgeon will perform your ACL surgery. An orthopedic surgeon specializes in the medical and surgical treatment of diseases of the bones and connective tissues.

How is anterior cruciate ligament (ACL) surgery performed?

Patients often need physical therapy for at least three weeks before ACL surgery. You may need to wear a knee brace during this period. The purpose of pre-operative physical therapy is to gain full range of motion in your knee before surgery. Patients who have ACL surgery while their knee is still stiff, swollen, or limited in motion tend to have trouble regaining motion after surgery.

Surgical approaches to ACL surgery

ACL surgery is performed in a hospital or outpatient surgery setting. It is a minimally invasive or arthroscopic surgery. Your surgeon will insert special instruments and an arthroscope through small incisions in your knee. An arthroscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your body to a video screen viewed by your surgeon during the surgery.

Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it uses smaller incisions and causes less damage to tissues and organs.  The arthroscope allows your surgeon to thread surgical tools around structures instead of cutting through or displacing them as in open surgery. 

Using an autograft for ACL reconstruction involves making a large incision over the autograft tendon. Because of this, autografts lengthen surgery time and tend to cause more post-operative pain.

Your surgeon will also advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different ACL surgery procedures and ask why your surgeon will use a particular procedure for you.

Types of anesthesia that may be used

Your surgeon will perform ACL surgery using either general anesthesia or regional anesthesia, depending on the specific procedure. 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site. It controls pain during and after surgery.
  • Regional anesthesia is also known as a nerve block.  It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable. 

What to expect the day of your ACL surgery

The day of your surgery, you can expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
  • Talk with the anesthesiologist or nurse anesthetist about your medical history and anesthesia 
  • A surgical team member will start an IV.
  • The anesthesiologist or nurse anesthetist will start your anesthesia. 
  • A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen. 
  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the surgery and your recovery until you are alert, breathing effectively, and your vital signs are stable.