ACL Reconstruction

Overview

ACL reconstruction and ACL repair both are same. The anterior cruciate ligament (ACL) is one of the 4 knee ligaments that connect the femur to the tibia and holds the bones of the knee together. It is the band of tissues in the knee that helps in keeping the knee stable. ACL is one of the commonly injured ligaments of the knee and most commonly occurs in players of high-risk sports, such as football, basketball, soccer, and skiing. Very rarely the only ACL is injured as any injury to the knee causes damage to other structures too.

What can cause an injury to ACL?

An injury to ACL occurs when it stretches too much or tears apart due to overstretching. This can occur in the following conditions:

Turning sharply or moving suddenly while running or jumping
Stopping suddenly and then changing direction
Jumping and landing

Symptoms of ACL injury

Many people hear a “pop” like voice when ACL gets injured. Also, in most of the cases, an injury to the ACL is often associated with injury to other knee structures and the symptoms revolve around knee including:

Difficulty putting pressure on the knee
Pain while walking
Rapid swelling over knee joint
Loss of range of motion of the knee
Knee stiffness and instability
‘Giving way’ of the knee joint

What all examinations are done to diagnose ACL injury?

ACL injury requires thorough examination and diagnostics for its evaluation. The process of diagnosis involves the following:

Clinical exam: First and foremost, the doctor takes the patient history and notes down his prime complaints. He will also ask the patient for any recent history of injury or fall during sports activity or sudden twisting of the knee joint. After knowing these details, the doctor performs a physical examination of the patient and will feel his knee joint (palpate) for any tenderness and warmth. He will also move the knee and leg into different positions and watch the patient walk to find out the injury.
X-ray: In almost all the cases, an X-ray of the knee joint is done to determine the presence of any fractures and the extent of the damage.
MRI scan: MRI may also be required in some cases to evaluate the extent of the ACL tear and find out if there is any concurrent damage to the other ligaments and cartilage of the knee joint.
Exploratory arthroscopy: In very rare cases, exploratory arthroscopy is done to see the inside of the knee as well as ACL and other ligaments to determine what kind of treatment will be appropriate for the patient.

Treatment

In most of the cases of a minor ACL tear, non-surgical methods of treatment like RICE (rest, ice, gentle compression, and elevation), joint immobilization or physical therapy give relief to the patient. Recovery and rehabilitation of the ACL injury usually take at least 3 months.

In cases of complete ACL rupture or tear that is also associated with other joint injuries, surgery is indicated to repair or reconstruct ACL and treat the adjoining structures for complete joint relief. So, collaborated surgery is done to repair all the defects. Also, sewing of ACL doe does not allow proper healing of the ligament, so its repair is mostly done using a graft from some other part of the body like tendon of the kneecap (patellar tendon) or the hamstring tendons.

Indications for surgery in ACL rupture

Active adult patients who are often involved in sports that require immediate turning or twisting of knee joint
Adults with jobs that require heavy manual work
ACL repair surgery in children should be delayed until skeletal maturity
Patient with significant functional instability of the knee joint
Patients with combined damage to the knee joint menisci, collateral ligaments, articular cartilage etc.

The procedure

The surgery to repair or reconstruct torn ACL can be done as “open” surgery in which a large incision is given in the knee joint or as an “arthroscopic” surgery which is a less-invasive option and is done through various smaller incisions. Nowadays in most of the cases, the arthroscopic procedure opts for ACL repair.

The arthroscopic ACL repair can be done under general or local anesthesia, but general anesthesia is preferred to ensure the proper relaxing of the muscles surrounding the joint to conduct the procedure. It requires 4 small incisions in the knee joint to insert arthroscope and other small instruments in the knee joint for the surgery. In one of the ways, the surgeon uses hamstring tendon grafts to repair the torn ACL. But if the reconstruction of multiple ligaments is required then different graft materials may be used. Specially designed screws are used for immediate fixation of the graft into the knee.

Advantages of Arthroscopic ACL repair

The procedure is quick and takes less than an hour
Arthroscopic procedures are mostly done as day care procedures and night stay is not required in the hospital
People with desk jobs can return to work as early as 1-2 days
There is negligible blood loss with arthroscopic procedures
The incisions are very small and hide in joint skin layers
There are fewer risks than open surgery

Post-Procedure

The patient is kept in the post-operative recovery room for a few hours to monitor any signs of discomfort in the knee joint.
The joint is heavily padded and pain relief medications and antibiotics to prevent infection are started soon after surgery.
In most cases, ambulation is started on the same day. Some patients may require crutches for the first few days.
A gradual increase in walking distance is advised to the patient
Regular movement of the knee should be carried out even while sitting or lying down through a different range of motion as tolerated.
The operated knee should be kept elevated above the level of heart with two pillows under the entire leg for the first few days after surgery.
Apply an ice pack to the knee to prevent swelling and pain.
The patient should do thigh muscle tightening exercises for the first few weeks after surgery.
Physical therapy, if required, may be started 3-5 days after surgery Results of ACL Repair

Most of the patients can bear weight on the operated knee and walk comfortably soon after the surgery. Driving and other minor activities can be started the day after the surgery. Patients with a sitting job can resume work as early as 1-2 days, while heavy manual employment may require 6 weeks. It may take almost 6 weeks to start running in a straight line. Slowly other activities are introduced, and the patient can get back to a usual lifestyle within 6 months after the surgery.

Why NICE ?

We are associated with the best hospitals globally having the emergency infrastructure, fully equipped with the latest technologies and techniques to overcome from every emergency condition.
Our team of doctors are highly experienced in ‘Emergency Patient Management’ and work together to save the patient.
Consultation from doctors through e-mail, phone, and video calling.
Rehabilitation programs are organized to assist complex surgery patients.
Complete support and assistance being given before and after treatment.
Cost of treatment is quite less as compared to other service providers.
We are always ready to offer our helping hand and our services are available 24/7.