ACL injury (tear) and reconstruction

ACL injury :-

 
  Anterior cruciate ligament is the one of the most commonly injured ligaments of the knee, which also called ACL .
In the general population ACL tear is very common. It most probably occure in the  people who participate in high-risk sports, like basketball, football, skiing, and soccer etc. However,ACL injuries are very commonly seen with road traffic accidents also.

As sports activities increase day by day from last few decades, the number of acl injuries increases.
This injury has received a great deal of attention from orthopedic surgeons over the past 15 years,
and now become one of the most successful surgeries in the field of Arthroscopic surgery today.

ACL, is one of four ligaments that are important for the stability of the knee joint. A ligament is a structure which is made of tough fibrous material and connects bone to a bone. There are over 250,000 ACL injuries per year in india.

Structure of knee bone :-

The structure of the knee joint is formed by - the femur, the tibia(shin bone), and the patella (knee cap).

 Four main ligaments within the knee that connect the femur to the tibia and ACL is one of that ligaments.
The knee is essentially a hinged joint that is held together by - 

• Medial collateral (MCL),  
• Lateral collateral (LCL),
• Anterior cruciate (ACL) and
• Posterior cruciate (PCL) ligaments.

 The ACL runs diagonally in the middle of the knee joint, preventing the tibia from sliding out in front of the femur as well as providing rotational stability to the knee.

The weight-bearing surface of the knee is covered by a layer of articular cartilage. On either side of the joint, between the cartilage surfaces of the femur and tibia, are the medial meniscus and lateral meniscus. The menisci act as shock absorber and work with the cartilage to reduce the stress between the tibia and the femur.

What happened when you got ACL injury:-

When a person got  ACL injury, Immediately after the injury, patient usually experience pain and
swelling and the knee feels unstable and patients often have a large amount of knee swelling, a loss
of full range of motion, pain or tenderness along the joint line and discomfort while walking.
this instability caused by the torn ligament leads to a feeling of insecurity and giving way of the knee,
especially when trying to change direction on the knee. The knee may feel like it wants to slip backwards.
The ACL injury is a problem because this instability can make sudden, pivoting movements difficult.
 An ACL injury may also make the knee more prone to develop meniscal and articular cartilage injuries, which can be cause that is turn into the pain in the knee and early arthritis.
The pain and swelling from the initial injury will usually be gone after two to four weeks, but the knee may still feel unstable. The symptom of instability and the inability to trust the knee for support are what require treatment. Also important in the decision about treatment is the growing realization that long-term instability leads to early arthritis of the knee.

In short, symptoms of acl tear are following:-

•  Sudden giving way of the knee
•  Hearing a 'pop' at the time of injury
•  Sudden swelling of the knee joint after an injury
•  Pain in the knee when walking

If an ACL tear is suspected, you will have to return for follow-up evaluation with your orthopaedic surgeon.

Evaluation of ACL tear:-

The mechanism of injury occurs the ACL injury is partially or fully torn. An injury to a ligament is also known as a sprain.The treatment is influence by the severity of the sprain. Severe sprain (complete tear) of the ACL is a problem as the knee has lost one of its main stabilizers.
For an athlete, an injury to the ACL can make continued participation difficult. Many sports require a
functioning ACL to perform common maneuvers such as cutting, pivoting, and sudden turns.
perhaps, Patients is able to function in their normal daily activities without a normal ACL, but in sports activities may prove difficult. Therefore, athletes often decide to undergo surgery in order to get back to their previous level of competition.

ACL tear is non-operated or operated:-

Some patients who experience ACL tears are able to resume normal daily activities without surgical
reconstruction of thier ligament. There are some important factors to consider in making the decision as to whether or not operative treatment of an ACL tear is needed.
The decision whether or not to operate on an ACL tear is dependent on several factors. These factors includes-

•  the age of the patient,
•  the activity level of the patient (both recreational and occupational),
•  the expectations of the patient,
•  the ability and willingness of the patient to participate in post-operative rehabilitation,
•  the degree of instability of the joint and any other associated injuries to the knee (e.g. other ligamentous or menisci problems).

What is the surgical treatment for ACL reconstruction?


ACL tears are not usually repaired using suture to sew it back together, because repaired ACLs
 have generally been shown to fail over time.Therefore, the torn ACL is generally replaced by a substitute graft made of tendon. The grafts commonly used to replace the ACL include:

Patellar tendon autograft (autograft comes from the patient)  Hamstring tendon autograft
Quadriceps tendon autograft
Allograft (taken from a cadaver) patellar tendon, Achilles tendon, semitendinosus, gracilis, or posterior tibialis tendon.
Patients treated with surgical reconstruction of the ACL have long-term success rate. The goal of the ACL reconstruction surgery is to prevent instability and restore the function of the torn ligament, creating a stable knee.
This allows the patient to return to sports. There are certain factors that the patient must consider when deciding for or against ACL surgery.

Rehabilitation program :-

ACL reconstruction is usually not performed until several weeks after the injury. This time allows the
 inflamed and irritated knee to quiet. As the swelling and inflammation decrease, the range of motion of the knee improves. Resolution of swelling and stiffness prior to ACL reconstruction surgery improves the post-operative function of the joint.
Once I have surgery, when can I play again?

ACL reconstruction surgery needs a four to six months rehabilitation program post-operatively. This is usually broken up into three phases with activities increasing with the strength of the healing ligament. It is extremely important to be compliant with the post operative rehabilitation. Engaging in higher stress activities when the tissues are not yet healed and the muscles are not fully functioning can lead to early failure of the ACL. Most athletes are able to return to running at 8 weeks, plyometrics and agilities by 12 weeks and sport at four to six months. Return to sport is evaluated on an individual basis and will ultimately be determined by the surgeon.