The anterior cruciate ligament (ACL) is the major stabilizing ligament of the knee. The ACL is located in the center of the knee joint and joins the femur (thigh bone) to the tibia (shin bone), passing through the center of the knee. In this position, its primary function is to prevent a buckling type of instability in the knee. These ligaments are tough, non-stretchable fibers, which help in holding your bones together. The cruciate ligaments in your knee joints crisscross to provide stability for your feet.
In most of the cases, people often damage the ACL by changing directions rapidly, slowing down from running or landing from a jump. They often feel or hear a popping sensation, suffer from rapid onset of swelling, and develop a buckling sensation in the knee when they try to change direction.
If the patient is an active participant in sports that involve running, specially those, which include sudden decelerations, high-impact landings, possible collisions with other athletes, and rapid changes of direction, ACL-restoration surgery is a must. The ACL is a constrainer and controller of knee motion and ensures stability in the knee, without which your knee is inherently unstable and is likely to trouble at an inopportune moment. In addition to it, the surgery reduces your risk of future cartilage damage.
Operative Procedure
The doctors usually do the diagnosis by determining the mechanism of injury, examining the knee, checking the presence or absence of blood within the joint and by conducting other tests. It may include X-rays, MRI scans and stress test of ligament.
The first treatment includes rest, ice compression and elevation (RICE) plus a brace to mobilize the knee, crutches and pain relievers. However, in most of the cases, doctors advise ACL reconstruction surgery.
Usually the surgical treatment of knee involves an orthroscopic surgical reconstruction of the injured ligament. In surgery, the doctor replaces the damaged ACL with strong and healthy tissues taken from another area near your knee. A strip of tendon can be used from under patient's kneecap (patellar tendon) or hamstring. The tissues are threaded through the inside of your knee joint and secure the end to your thighbone and shinbone. In few cases, when the ACL is torn cleanly from the bone, it can be repaired. The people, who are less active or who are not active participants in sports can be treated non-surgically.
Time Involved and Possible Complications
The possible risk involved in surgery is significant knee disability and it occurs when the ACL graft is fixed incorrectly or placed tensioned. These problems mainly occur due to technical faults. Other risks involved are infection or damage due to fall. Therefore, every care must be taken to ensure proper surgery and graft fixation because revised ACL surgery results are not as predictable as those of primary procedures.
The time usually involved in surgery is 45 minutes to 1 hour. After that, the patient can be discharged to go home. Within a week he/she can start walking with the help of crutches, and within a month, braces are fixed on patient's knee. The patient can now walk on his own legs. These braces are kept for 2 months and after that these are removed and the patient is given a kneecap, which he/she has to use for 6 months.
Post-Operative Care and Rehabilitation
Physiotherapy is an important part of successful ACL surgery, with exercises beginning just after the surgery. The success mainly depends on the patient's dedication to rigorous physical exercise. With advance surgical procedures and stronger graft fixation, current physical therapy uses an accelerated course of rehabilitation.
In the starting days after surgery say 10 to 15 days, the wound is kept clean and dry, and emphasis is laid down on regaining the ability to fully straighten the knee and restore quadriceps control. The knee is iced regularly to reduce swelling and pain. The patient may be advised for the use of a post-operative brace and machines to move the knee through its range of motion.
The goal of these exercises is to reduce knee swelling, maintaining the mobility of kneecap to prevent anterior knee pain problems, gaining back full range of motion of the knee, as well as strengthening the quadriceps and hamstring muscles. The patient may return to active life and sports if he no longer suffers from pain or swelling, when he achieves full range of motion and when full muscle strength and leg functionality has been restored
