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Anterior Cruciate Ligament Reconstruction

Anterior Cruciate Ligament Reconstruction - What it is

One of the most common knee injuries is an anterior cruciate ligament (ACL) sprain or tear.
Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments.

If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.

Anterior Cruciate Ligament Reconstruction - Symptoms

When you injure your anterior cruciate ligament, you might hear a "pop’ sound and you may feel your knee give way. 

Other typical symptoms include:

  • Pain with swelling. 

  • Loss of movement

  • Tenderness 

  • Discomfort while walking


Anterior Cruciate Ligament Reconstruction - How to prevent?

Anterior Cruciate Ligament Reconstruction - Causes and Risk Factors

The anterior cruciate ligament can be injured in several ways:
  • Changing direction rapidly
  • Stopping suddenly
  • Slowing down while running
  • Landing from a jump incorrectly
  • Direct contact or collision, such as a football tackle


Anterior Cruciate Ligament Reconstruction - Diagnosis

On your first visit, your doctor will talk to you about your symptoms and medical history.
Doctor will perform physical examination and check all the structures of your injured knee, and compare them to your non-injured knee. Most ligament injuries can be diagnosed with a thorough physical examination of the knee.
Other tests which may help your doctor confirm your diagnosis include:
  • X-rays- X-rays can show whether the injury is associated with a broken bone.
  • Magnetic resonance imaging (MRI) scan- MRI creates better images of soft tissues like ACL. 

Anterior Cruciate Ligament Reconstruction - Treatments

Treatment for an ACL tear will vary depending upon the individual’s needs. 

Nonsurgical Treatment

A torn ACL will not heal without surgery. A nonsurgical treatment may be effective for patients who are elderly or have a very low activity level. If the overall stability of the knee is intact, your doctor may recommend nonsurgical options such as the following:
  • Bracing- A brace is used to protect your knee from instability. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.
  • Physiotherapy- As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it.

Surgical Treatment

To surgically repair the torn ACL, and restore knee stability, the ligament must be reconstructed. A tissue graft will be used to replace your torn ligament. This graft acts as a scaffolding for a new ligament to grow on.
Grafts can be obtained from several sources:
Patellar tendon
Hamstring or quadriceps tendons
Cadaver graft (allograft) 
There are advantages and disadvantages to all graft sources. Your own orthopaedic surgeon to help determine which graft is suitable for you. 

Surgical Procedure

ACL reconstruction is done with an arthroscope using small incisions. Arthroscopic surgery is less invsive. The benefits of using invasive techniques include less pain from surgery, shorter length of stay in the hospital, and quicker recovery times.

Rehabilitation

Rehabilitation plays a vital role in getting you back to your daily activities. A physiotherapy program will help you regain knee strength and motion.

If you have surgery, the physiotherapist focuses on returning motion to the joint and surrounding muscles. This is followed by a strengthening whichis designed to protect the new ligament. This strengthening will gradually increase the stress across the ligament. The final phase of rehabilitation is aimed at a functional return.

Anterior Cruciate Ligament Reconstruction - Preparing for surgery

Once your orthopaedic surgeon has recommended an ACL reconstruction, you will need to do some physiotherapy in order to reduce the internal swelling and inflammation as much as possible before surgery. 

Preparation - Make sure you understand the potential risks and benefits of the surgery. 
  • Talk to your surgeon- Tell your surgeon about any health problems, such as a fever or infection, and all the medications you are taking.
  • Follow instructions- You will be instructed not to eat and drink after midnight on the night before your surgery. This will reduce the risk of vomiting while under general anesthesia.
  • Arrange transportation – You will need to make arrangement and get a family member or friend to drive you home
  • Practice with crutches- You will need crutches after surgery. Practice using them before the surgery.
  • Dress comfortably - Wear loose pants or other clothing that will fit comfortably over your knee bandage when you discharge from the hospital.



Anterior Cruciate Ligament Reconstruction - Post-surgery care

After ACL surgery, move your ankles up and down an average of 10 times every 10 minutes. Continue this exercise for two to three days to promote blood circulation and to prevent blood clots from forming in your legs. 

Elevation

Keep your operated leg elevated with a pillow. Do not put pillows behind your knee because this limits motion of the knee. Place the pillow under your heel and calf.

Take pain medication

Expected pain and discomfort for the first few days. Take pain medications s prescribed. 

Care of wound dressing

The dressing on your knee is usually removed the day after surgery. Keep the wound clean and dry. 
Monitor for signs and symptoms of infection
  • Fever
  • Inrease in pain 
  • Discharges from the surgical wound
  • Redness and swelling 

Knee Brace

  • Keep knee brace on as instructed by your surgeon. DO NOT attempt to adjust the degree of the knee brace
  • Knee brace should be worn continuously for the first six weeks even while you are asleep 
  • All straps of the knee brace should be tightened to prevent slip when walking

Physiotherapy

You will be reviewed by a physiotherapist after surgery. The therapist will discuss with you regarding your rehabilitation program.

Anterior Cruciate Ligament Reconstruction - Other Information

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