You must have heard so many questions like What is ACL tear surgery? What do you mean by Anterior cruciate ligament tear? what happens when ACL got teared up due to some accidental injury? when ACL injury require surgery? etc….

So today through this article, you will get all the answer to the question that you have heard about Anterior Cruciate Ligament surgery that is, an ACL tear surgery

Hello, this is Anil K Sharma, a well known orthopedic cum arthroscopic surgeon from Jaipur. Presently, I am working as an Arthroscopic, Joint Replacement, Foot and Ankle Surgeon specialist in Sawai Man Singh Hospital, Jaipur(SMS). This article helps you to understand in detail of Anterior Cruciate Ligament(ACL) and the pathophysiology of an ACL tear and what treatment option available for such type of tear injury.

This article is intended to assist the patient in making best-informed decision possible regarding management of ACL injury.

ACL(Anterior Cruciate Ligament) tear surgery

The bone structure of the knee joint is formed by the three components, first is the femur also known as thigh bone, the tibia also known as leg bone and the third patella who also know as knee cap.

There is four ligaments who provide stability to knee joints. ACL is one of the ligament in the knee that connects the femur to the tibia.

The knee is basically a hinge joint that got stable by the four ligaments names as the medial collateral ligament, lateral collateral ligament, anterior collateral ligament, and posterior cruciate ligament.

The ACL is a ligament that placed just behind a patella or knee cap. It preventing the tibia from sliding out in front of the femur. Due to this, the knee will get stability.

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. Both menisci act as shock absorbers and work with cartilage to reduce stresses between the tibia and femur and provide flexibility to the knee movement.

Surgical Procedure

ACL tear surgery usually begins with an examination of the patient’s knee while the patient is relaxed due to the effects of anesthesia. The surgeon does their examination to verify that ACL torn level and check the looseness of other knee ligaments that may need to repair during surgery.

If the result is positive mean ACL is actually torn, then, the selected tendon is harvested and the graft is prepared of same tendon size for the patients.

When this graft prepared, the surgeon places an arthroscope into the joint. Small(1cm) incision called portals is done by the surgeon in front of the knee to insert an instrument named as arthroscope and see the condition of the knee.

If it seems that meniscus and cartilage both are injured, the surgeon first repair or trimmed them and then the torn ACL stump will be removed.

After removing torn ACL stump, then bone tunnels are drilled into the tibia and the femur to place the new ACL graft in almost the same position as torn ACL. Then, the surgeon will place a small screw in the tunnels and either at both ends of the new graft to fix a new ACL properly.

Over to 6-8 weeks, the bone growth will fill these tunnel gap and make the new graft stabilized.

At the end of the procedure, the surgeon will remove the instrument and close the incisions. The whole “ACL tear surgery” takes about 1 hour or 1 ½ hour.

Before a surgery complete, a surgeon makes sure that a new graft must have good density and also verify that the knee has the full range of motion and perform test such as Lachman’s test to assess new ACL graft stability.

Non-surgical Treatment

Under non-surgical treatment, progressive physical therapy or exercises and rehabilitation play a vital role to restore the knee to a condition close to its pre-injury state and doctor’s educate the patient on how they can prevent instability.

This may be supplement with the use of a flexible knee joint brace. However, many people who choose a non-surgical option may experience secondary injury to the knee due to repetitive instability.

Surgical treatment is usually advised when a patient facing a pain of both ACL tear other knee joint injuries.

Following are the cases when Non-surgical treatment advice to patients-

  1. Partial ACL tear and no instability symptoms.
  2. Complete ACL tear and no symptoms of knee instability as the patient don’t do heavy or sporty manual work.

Rehabilitation

Physical therapy exercises consider a crucial part of successful  “ACL tear surgery”, with exercises beginning immediately after the surgery. Much of the success of ACL reconstructive surgery depends on the patient’s dedication to rigorous physical therapy exercises. With new surgical technique and strong graft fixation, present physical therapy exercises use a preferable course of rehabilitation.

The goal for rehabilitation of ACL reconstruction involves reducing the knee swelling, maintaining mobility of knee cap to prevent anterior knee pain problems, restoring full range of knee motion, strengthening the quadriceps and hamstring muscles as well.

The doctor or surgeon advised a patient to start their day to day routine activities when there is no longer pain or swelling, when knee starts moving properly, muscle strength, endurance and functional use of leg have been fully restored.

The doctor makes sure that the patient’s sense of balance and control of the leg must also be restored through an exercise designed to improve neuromuscular control. This would take around 4-6 months.

The use of functional brace when returning to the sport is not required after a successful ACL reconstruction but some patients may feel security by wearing one.

Pain management

After completing surgery, a patient may feel pain. This a part of the natural healing process. The patient will get some medicine for reducing such pain.

Medications are often prescribed by the doctors for short term relief after surgery. Several types of medicine are available in the market to help manage pain, including opioid, non–steroidal anti-inflammatory drugs (NSAIDs) and local anesthetics.  The doctor may provide a combination of these medications to reduce pain.

Be aware of consuming opioids although it helps in pain relief after surgery as it’s a narcotic so excess or over the use of it may make patients addictive. That’s why a patient must get these medicine after prescribing by the doctor and stop when pain begins to improve.

I hope you enjoyed the whole article and have cleared your doubt ACL tear surgery.

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