What is ACL Reconstruction?
ACL reconstruction is a surgical procedure which is done to reconstruct an important knee ligament called the anterior cruciate ligament. The ACL is one of the major ligaments that crosses the front of the knee and connects the thigh bone to the shin bone. This ligament is commonly injured when participating in sports. The surgery is generally performed using minimally invasive arthroscopic techniques.
How does an ACL Injury Occur?
The ACL is often injured when performing activities that put stress on your knees such as:
- Rapidly changing direction or speed while running
- Pivoting on the knee
- Direct blow to the knee
- Stopping abruptly while running
- Landing improperly from a jump
When is ACL Reconstruction Recommended?
An ACL reconstruction may be recommended in case of:
- Athletes who wish to return to sports
- Young or active individuals who maintain an active lifestyle
- Injury to multiple knee ligaments
- Injury to the knee meniscus (along with ACL)
What happens if an ACL injury is left untreated?
An untreated ACL tear can result in your knee buckling or giving away during physical activity, particularly cross over movements or side step movements. (early arthiritis, loss of knee control, frequent falls).
Preparing for ACL Reconstruction
In preparation for the surgery, you may be recommended to:
- Perform exercises to strength the muscles around the knee and improve range of motion.
- Inform Dr. Laxman of your current medications and allergies.
- You may be required to do certain tests to ensure you are fit to undergo the surgery.
- Follow Dr. Laxman’s instructions regarding when to stop taking certain medications and food before the ACL reconstruction.
What happens during ACL Reconstruction?
The surgery may be performed generally under spinal anaesthesia. Doctor generally speaks to the patients during surgery ,so you can decide whether you want to sleep through the surgery or be awake. Small keyhole incisions will be made over the knee through which an arthroscope and special surgical instruments will be inserted. The arthroscope gives Dr. Laxman a magnified view of the inside of the knee. Dr. Laxman will prepare the damaged ACL ligament and reconstruct it with a graft obtained from a portion of healthy but unused tendon in the kneecap or hamstring region. Tunnels will be made to position the graft precisely in the anatomical location and it will be attached securely with bioscrews, which generally dissolves after a year. Local anaesthetic may infiltrated at the end of the procedure to help control postsurgical pain. A surgical dressing will be applied to protect the incision site.
Recovery after ACL Reconstruction
Following arthroscopic ACL reconstruction, you can expect to return home on the same day as the procedure or after an overnight stay. You will be given medication to control postsurgical pain and swelling. Use of crutches and a knee brace may be necessary for few days after surgery. You will be instructed on how to take care of your surgical incision and physical therapy exercises to be done daily to speed up your recovery.
How soon can i have surgery for a torn acl?
Often the best time to have reconstructive surgery is 2-3 weeks after the injury. This is before muscle wasting and knee stiffness has occurred. This will result in the fastest recovery. During this 2-3 weeks physiotherapy ,rehabilitation or Pre -Hab is recommended. Dr Rewat prescribes a individualised Pre-Hab Protocol for each and every patient after careful prescription.
If there has been a delay in the diagnosis then sometimes the knee has become stiff, It may take several weeks of rehabilitation to restore movement before surgery can proceed safely.
A few weeks of “pre-hab” can take months off the recovery time if stiffness is an issue.
Can i delay surgery for an acl tear?
In general terms, reconstructive surgery is not urgent and can be delayed to fit around work and personal schedules. During this time, sport and change of direction activities should be avoided. It is important to continue physiotherapy during the time.
If there are other injuries such as a meniscal tear which might be a suitable for repair, then you may be advised to have surgery sooner rather than later.
Can an acl tear heal?
In the great majority of cases, anterior cruciate ligament tears are complete tears of the ligament and healing capacity is very limited. One of the reasons for this is that the tear occurs in a fluid environment. The knee joint contains articular fluid which bathes the torn area and prevents healing.
Sometimes limited healing will occur and can provide an adequate level of stability. Alternatively, the ligament may heal but is longer than it should be and this can still allow for the knee joint to be unstable.
What happens if i don’t have an acl reconstruction?
The anterior cruciate ligament provides stability to the knee particularly with twisting, turning and change of direction activities. Immediately after an ACL tear, your knee will be sore but the pain will settle provided there are no other injuries. The end result of the cruciate ligament tear is an unstable knee, not a painful knee. Most people with an anterior cruciate ligament tear are unable to return to competitive sporting activities without reconstruction. Cruciate ligament reconstruction surgery is undertaken to restore stability to the knee joint to improve quality of life and allow sporting activities.
It is also generally accepted that an unstable knee with a torn cruciate ligament is more likely to develop arthritis in the longer term. The risk of arthritis after an ACL tear is increased but that does not mean that it occurs in all patients.
What type of graft should i have for my acl reconstruction?
There are many options for graft tissue but the commonest in use today is hamstring tendon tissue. Although much attention is paid to graft choice, it is not the most important factor in the success of surgery.
Dr Rewat will suggest the following grafts:-
- Bone -Patellar Tendon - Bone Graft
- Hamstring Graft
- Peroneus Longus Graft
All these grafts are autografts,Pros & Cons Of Each will be explained to you in Detail.
How long do you have to be on crutches after acl surgery?
Most patients use Walker for 2 week but take weight on the leg (partial weight bearing) immediately. You should be full weight bearing without crutches after 4weeks if possible.
How long do you need a brace after acl reconstruction?
Dr Rewat advise that a Long Knee brace should be worn for 2 weeks followed by hinged knee brace for 4 weeks.
What rehabilitation will i need after acl reconstruction?
In case of an ACL tear and an ACL reconstruction, it is desirable to have a physiotherapist supervise your recovery. Their job is to instruct you on the exercises to perform. You then undertake those exercises for twenty to thirty minutes, three times a day in the first six weeks.
When can you start driving after acl surgery?
You are not fit to drive until six weeks,you can drive an automatic after 6 weeks. You need to be able to stand on 1 leg for 2 minute to be fit to drive.
How soon can you return to work after acl surgery?
It is safe to allow at least one week before you resume office duties. Light physical duties can resume at six weeks post surgery and a manual occupation is usually deferred until twelve weeks post surgery.
If your occupation involves ladders, scaffolding or roofs, then these duties should be held off until four months post surgery.
When can i play sport after acl reconstruction?
Swimming and exercise bike can start six weeks post surgery. Jogging starts approximately 10-12 weeks post surgery.
A return to competitive sports and twisting and turning activities is at 7-9 Months post surgery.