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The ACL or anterior cruciate ligament is a major cross-shaped ligament that connects the upper leg to the lower leg and provides stability to the knee. It is one of the most commonly injured structures in the knee. It is estimated that about 200,000 ACL injuries occur annually, and about 100,000 ACL reconstructions are done every year. ACL injury is highest among athletes engaged in high-risk sports, including basketball, football, soccer, and skiing.

Injury to the ACL may result in partial (more common) or complete tearing of the ligament. Surgical treatment consists not of repairing the ligament because it usually ends in failure, but of replacing the torn ligament with a graft from another tendon, usually coming from the patient himself (called an autograft).

The goal of treatment is to stabilize the knee and to restore its function.

Reconstruction of the ACL is considered to be a safe procedure. The success rate of ACL surgery is about 82-95%. A few patients, however, experience recurrent knee instability and other complications from graft failure.

Studies show that there are five possible causes of graft failure and patient complications.These include graft discontinuity, which consists of a tear or impingement in the graft, inappropriate positioning of the graft, hardware failure (screws not in their right position), infection, and arthrofibrosis.

The most commonly reported complication is the loss or limitation of motion of the knee, which is usually called arthrofibrosis.

Stiffness of the knee may be due to scarring and inadequate rehabilitation.

Some people feel some grating (crepitus) of the kneecap after surgery, which may be painful, causing limitation in movement. The kneecap may have been fractured during surgery or due to a fall after surgery. During the process of healing the graft may be stretched, torn, or ruptured, causing pain and difficulties with certain movements. This can also cause recurrent instability of the knee.

Kneecap pain is very common after ACL reconstruction and the incidence of pain on kneeling may be as high as 42% after surgery.

The incidence of post-operative infection ranges from 0.2 to 0.48 percent. Other problems include damage to other structures in the leg, such as nerves and blood vessels, numbness around the knee, and blood clots in the leg (deep vein thrombosis).

Hardware problems involving irritation from the screws and staples that attach the graft to the leg bones may cause pain and discomfort.

Many experts warn that after ACL surgery, the knee may never become normal again. However, most patients can return to their normal activities with proper rehabilitation. A few patients who have residual knee pain, instability or other complications may need another surgery to revise the first ACL reconstruction.


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