ACL reconstruction is surgical procedure to replace a torn anterior cruciate ligament (ACL) — a major ligament of the knee. The bone structure of the knee joint is formed by the femur, the tibia, and the patella. The ACL is one of the four main ligaments within the knee that connect the femur to the tibia.
PREPARING FOR THE SURGERY
In order to achieve proper healing post-surgery, you will have to undergo several weeks of physiotherapy before the surgery. This is to ensure that your pain and swelling is reduced and your knee’s full range of motion and muscle strengthening is restored. If you take certain blood-thinning medications, your doctor may ask you to stop taking these types of drugs or supplements from at least a week before surgery to reduce your risk of bleeding.
ON THE DAY OF SURGERY
ACL reconstruction is mostly done under general anaesthesia and sometimes under regional or spinal anaesthesia. Nowadays, ACL reconstruction is commonly done through Arthroscopy in which doctor will insert tiny tools and a camera through small cuts around your knee. There’s less scarring of the skin with this method than with open-knee surgery.
During ACL reconstruction, the surgeon removes the damaged ligament rather than repairing it. The damaged ligament is replaced with a segment of tendon, tissue similar to a ligament that connects muscle to bone. This replacement tissue is called a graft which is usually a piece of tendon from another part of your knee or a tendon from a deceased donor. Drilling is done to form sockets or tunnels into your thighbone to accurately position the graft, which is then secured to your bones with screws or other fixation devices. The graft will serve as a bridge on which new ligament tissue can grow as you heal.
ACL reconstruction surgery takes about an hour to complete. After you recover from anaesthesia, you will be able to go home on the same day of surgery. You may experience mild pain and will be asked to stay off your leg and rest the knee and wear a knee brace to protect the joint. You’ll probably need to use crutches to keep pressure off your knee.
Before your discharge, a physio-therapist will instruct you and plan an exercise program which you need to perform at home. To reduce swelling and pain in the days immediately after your surgery you should take proper rest and limit weight bearing on knee by taking help of crutches, apply ice on your knee at least every two hours for 20 minutes at a time, wrap an elastic bandage or compression wrap around your knee. And lie down with your knee elevated on pillows.
Recovery post a successful ACL reconstruction surgery majorly depends on how you adhere to the after-care instructions and follow regular exercise plans. Within the first few weeks after surgery, you would be able to move your knee and regain range of motion equal to that of your opposite knee. You would be able to walk-freely approximately after one month from the time of surgery. It may take six to nine months to return to full activity as new ligament needs time to heal and care is taken not to rip the graft. Athletes often can return to their sports after eight to 12 months.
ACL injuries most commonly occur during sports that involve sprinting and quick changes in direction. It is generally recommended if:
The basic requirement of ACL Reconstruction are:
The patient will undergo some diagnostic and evaluative tests before being cleared for surgery:
The orthopedic surgeon will remove the torn ligament from your knee and replace it with new tissue. The primary aim is to get the knee stable again and give it the full motion it had before the patient got hurt. The replacement tissue is called a graft and it comes from another part of the knee or a tendon from a deceased donor.
The rehabilitation program to restore complete motion to the patient's knee begins immediately post surgery. The first week after surgery, most patients are encouraged to lift their legs without assistance while lying on their backs. By the end of the second or third week, patients usually walk without crutches. Sessions with a physiotherapist usually begin 7 to 14 days post-surgery. During physical therapy, light weight training can be incorporated as well.
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Q; How will I know if my ACL is torn?
A: Knee joint swells within a short time following the injury. The instability caused by the torn ligament leads to a feeling of inability to put weight on the leg and insecurity, especially when trying to change the direction on the knee.
Q: Can I bend my knee or walk with a torn ACL?
A: Due to a torn ACL, you won’t be able to bend your knee to about 90 degrees angle because of pain, stiffness and swelling. A torn ACL weakens the thigh muscles which makes it difficult for you to lift your leg or even straighten it.
Q: Is surgery the only option for torn ACL?
A: ACL treatment depends on the extent of inability caused by the injury. If knee is stable and you are not actively involved in sports and physical activities, then non-surgical treatments may be considered.
Q: How long I will have to use crutches after the surgery?
A: Normally, you may start to put weight on your leg and walk freely two to three weeks after the surgery. Keep your leg elevated if your knee swells when you are up and about on crutches.
Q: What is the success rate of ACL reconstruction or can it fail?
A: ACL reconstruction has a success rate of 80-90%, but in some cases stiffness and pain persists leading to inability to return to desired activities. Treatment for failed ACL repair is complex and the results of revision ACL surgery are not as good as an initial ACL reconstruction.
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