ACL TEAR RECONSTRUCTION SURGERY

About the Knee

The knee joint is formed by the lower end of femur, upper end of tibia (leg bone) and patella (knee cap). The ligaments of the knee play a crucial role as they are the most important element in providing stability to the knee.

Ligaments of the Knee

The knee is stabilized by four main ligaments - two ligaments in the center of the joint (cruciate) and two ligaments on either side of the knee (collateral ligaments).The Anterior Cruciate Ligament (ACL) is in the front of the knee joint and it prevents the tibia from slipping forward. The Posterior Cruciate Ligament (PCL) is at the back of the knee and it prevents the tibia from slipping backwards. 

The collateral ligaments prevent abnormal sideward movements of the tibia. The Medial Collateral Ligament (MCL) stabilizes the inner side of the knee and the Lateral Collateral Ligament (LCL) along with a few more ligaments stabilizes the outer aspect of the knee.

How ACL is damaged

Body contact sports, road traffic accidents and awkward fall are common causes of ACL injury.

How do I know

Many people can hear a “CRACK” or “POP” at the time of injury, followed by immediate swelling and pain. Players often have to be carried off the field. Later there will be pain, weakness and a peculiar looseness of knee- giving way- the most disabling problem.

What is the treatment

It depends on your disability and your activities. In brief, if you are engaged in lots of outdoor activities and heavy work and not willing to restrict your activities then you need an operation to make a new ligament. This applies to most young and active people.

What is the operation

Operation is done in general or spinal anesthesia. At first inside of knee is examined by a telescope, which is introduced through small puncture (arthroscopy). Next a new ligament is prepared by taking few fibers from the tendons around knee. Generally the hamstring or patellar tendon is used.

This newly fashioned ligament is then placed inside the knee which grows and matures to take the function of original ligament.

What if I do not get operated

Other then the disabilities like giving way, pain, swelling etc. it is said to be the “Beginning of The End of Knee.” The knee suffers repeated injuries because of its undue laxity and early arthritis sets in.

 

ACL Surgery Guideline For patients

Preparation before the operation:

1. Arrange for a leave about one month from your work.

2. DO NOT eat or drink anything after Midnight. (NBM)

3. Report to hospital 8 a.m. – Please bring your all X ray and reports with you.

4. The hospital stay is usually 2-3 days – bring your clothes accordingly.

After operation

1. Exercise: Start the static quads exercise the same day. From next day a qualified physiotherapist will take you through a detailed exercise schedule.

2 .Walking:  You can stand up next morning and start walking. You will need the help of a stick or a pair of crutches for the first few weeks. However, walk minimally for first two weeks after operation.  This reduces pain, swelling and helps healing.

3. ICE- Compress: Put some crushed ice in a plastic bag, cover it with dry towel and place it on the knee for 15-30 minutes. Do it four times daily.

4. Dressing: Will be changed in the hospital the after the operation. No further dressing is usually necessary. Keep it dry until stitches are removed.

5. Stitch removal:  Usually done 12-14 day after operation.

6. Shower: Allowed only after 2 weeks, when stitches are removed.

7. Toilet: You should use commode for 2-3 months after operation (If you do not have commode at home arrange for a chair commode)

8. Driving:  You can drive a car after two months and a two wheeler after three months, provided you have good power and control of leg.

9. Activities: During first two weeks you should mostly rest in bed with leg elevated on a pillow, and do exercise as advised. Subsequent movements depend on your muscle strength and type of operation.

Generally, after 4 weeks one can join light office duties.

After 8 weeks one can join gym, ride a bicycle or drive a car.

After 4 months light on field activities are allowed.

After 6 to 9 months games can be played provided good muscle power is achieved.

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