Anterior cruciate ligament reconstruction

ACL complaints

The anterior cruciate ligament (ACL) is one of a pair of ligaments in the center of the knee joint that forms a cross. There is both an anterior cruciate ligament (ACL) and a posterior cruciate ligament (PCL). Both of these ligaments function to stabilize the knee from front-to-back during activities. The ligaments of the knee make sure that the weight that is transmitted through the knee joint is centered within the joint minimizing the amount of wear and tear on the cartilage inside the knee. Injury of the anterior cruciate ligament is not uncommon and will not heal by itself and suturing of a torn ACL is not an adequate cure.

The most common complaints:

A torned ACL usually gives sensation of instability. Such a tear is frequently sports-related. The knee usually swells up quickly and feels ‘unreliable’.
With stretching and rotating the knee does not support without the support of the anterior cruciate ligament. This may result in a varying degree to an acute increase in pain and swelling of the knee
Due to the "stump" of the torn ligament, a restriction can be caused by the stretching of the knee

Treatment of ACL

First conservative treatment is considered. With muscle strengthening and a consistent program emphasizing quadriceps and especially hamstring strengthening exercises is essential. Bracing is sometimes advocated for the ACL deficient knee in combination with rehabilitation and activity modification. If there is still lack of stability of the joint, in spite of therapeutic activities, surgery is necessary to rebuild the ligament.

Methods

A torn anterior cruciate ligament must be reconstructed with a tissue graft replacement:

hamstring muscle group (in the back of the thigh)
patellar tendon, the tendon connecting the knee cap to the shin bone (tibia), to fashion a new ligament.
donor tissue grafts.

Treatment

The surgery is performed under regional or general anesthesia.
During arthroscopic ACL reconstruction, the surgeon makes small incision in front of the lower part of the leg
The inside of the knee is assessed with the arthroscopy and meniscus tear or cartilage damage is treated as possible.
The remains of the torn anterior cruciate ligament are removed.
Carefully new channels are chosen and drilled through the bone and anterior cruciate ligament will be positioned
The surgeon secures the graft with screws or staples
Sterile saline solution is pumped into the knee to expand it and to wash blood from the area and will closed with stitches.
Finally, the knee is bandaged.

Preperation

How to prepare ACL surgery

Prior to your surgery, you will have a physical examination. You visit the doctor's assistant and/or anesthetist to check your health and explanation of the various forms of anesthesia and pain management, both during and after surgery. More information about anesthesia, you can read here.
The day of surgery is scheduled. You can return home on the on the same day of surgery.
You should borrow crutches as you will need them to walk for a few days following your surgery. For more information: www.thuiszorgwinkel.nl
After a reconstruction of the anterior cruciate ligament it is necessary to use crutches for a certain period. If the crutches are not adjusted for your height, please let us do in our clinic.
Usually you can walk with a crutch several weeks after a reconstruction of the anterior cruciate ligament.

The day of surgery

You should bring your crutches and personal items such as medicines. You wear comfortable clothing and shoes and leave valuables at home as much as possible.

You appear sober at the clinic.
After preparation you will positioned and treated in the operating room.
After surgery you will be moved to the recovery room and should be able to go home within 1 or 2 hours.
The physical therapist will explain how you can exercise at home and how to use the crutches safely.
When you are restored sufficiently, the surgeon or anesthesiologist will agree with your dismissal. You may not drive home by yourself.

Recovery after surgery

The recovery of the reconstruction takes 4 to 6 weeks. Consider a period of approx.9 months in which you perform exercises to get full recovery.

The recovery runs roughly as follows:

The knee will be thick and tender. Especially the days after surgery creates pain and swelling
You use two crutches. The first week is exercise with stretching and bending of the knee.
Usually 1 week after surgery you can use the leg almost with normal weight

The recovery of the anterior cruciate ligament is supervised by a physical therapist. Therapeutic exercise will play an important role in how well you recover also for sport activities. The formal physical therapy program may improve your final result.

Complications

Surgery is not without risks and complications can arise. Although the risk of a complication of this surgery is low, complications may be related to anesthesia or infections.

Consult your surgeon with the following complications:

Bleeding from the wounds or bleeding in the knee.
The wounds remain sensitive sometimes long after a knee arthroscopy.
There may be a thrombosis or pulmonary embolism occurs.
Infection of the knee
Damage to the knee arthroscopy structures, such as nerves or blood vessels.

Expectations

Sometimes instability still exists after surgery. A small percentage of patients keeps an unstable gain (<10%) but with intensive physiotherapy it will usually manage to create good stability. After a period of knee pain, in most cases, the joint will be pain free and stable.

Frequent asked questions (FAQ)

Why is suturing of the ACL not possible?
A torned anterior cruciate ligament will not heal, even if it is sutured.

When we use a hamstring tendon and patellar tendon when?
In general the patellar tendon is used for male patient’s practicising high-intensive sports. For each patient the most suitable technique for reconstruction of the anterior cruciate ligament will be discussed.

Do I need help at home after surgery?
You may feel groggy for the first 24-48 hours. Rest and give your body time to recover from surgery and anesthesia. For the first 24 hours after surgery you should not be left alone. This is if you need help or unforeseen problems arise. The first few days you are not as mobile as usual so it's nice when family or friends will give you a helping hand. Remember you cannot drive.

Is there an OK alternative, because of my medical history, for Delft Orthopedium?
The orthopedic surgeon will operate you in the Vlietland hospital at Schiedam.

When can I return to work, play sports and participate in traffic?
The time spent out of work can vary from a week to two depending on graft choice, transportation, and to type of occupation. Depending upon where your work is located and if you need to climb stairs, you should be able to return to some work starting about one week after surgery s depending on the progress of your recovery. Discuss this with your surgeon and read the policy conditions of your insurance.

When should I contact Orthopedium clinic?
For questions please contact us during business hours; you can reach us by phone 088-0088444.

Call Orthopedium with any questions you have about your healing or if you notice any of the following:

There is increasing pain and swelling in the knee
Continued bleeding through the bandage
Persistent swelling or warmth at the lower part of the leg

Why do I stay sober for the surgery?
You should be sober before a surgery otherwise you might vomit during the operation, which can cause suffocation or pneumonia.

How long takes an ACL surgery procedure?
The average duration of the session takes approx 1.5 hour.

Prepare yourself by reading all the information given. For any questions please telephone or email contact with Orthopedium.