What is Anterior Cruciate Ligament Surgery?
Anterior
cruciate ligament reconstruction surgery is an arthroscopic surgical procedure
done to repair a tear in ligament of the knee called the anterior cruciate
ligament.
The thigh
and leg bones (femur and tibia, respectively) that contribute to the knee are
held together with bands of tissue called ligaments with
surrounding capsule and muscles supporting them. Considering the amount of
movement at the knee that takes place against gravity, these ligaments have to
be very strong to withstand the stress that they are subjected to. A total of four ligaments support the knee joints. Two
ligaments, the anterior cruciate ligament (ACL) and the posterior cruciate
ligament are cross-shaped ligaments present within the knee joint. Two other
ligaments, the medial and lateral collateral ligaments are located on either
side of the knee.
The femur
and tibia have two eminences at their surface of contact with each other. The
eminences on the inner aspect of the knee are called the medial condyles, while
those at the outer aspect are called lateral condyles. The part between the
medial and lateral condyles is called the intercondylar region.
The
anterior cruciate ligament is attached to the intercondylar region of the
tibia, more towards the front of the joint. It
extends upwards and is attached to the inner aspect of the lateral condyle of
the femur, more towards the back of the joint. It consists of two bundles – the
anteromedial and posterolateral bundles. A third bundle called intermediate
bundle may also be present. When the knee is bent, the anteromedial bundle
becomes tight while the posterolateral bundle relaxes. The opposite happens
when the knee is straightened.
An injury to the
anterior cruciate ligament may make the knee unstable and warrant surgery. A torn anterior
cruciate ligament is usually a consequence of sports
injuries.
It may be noted some patients who are born with weak ligaments, like Ehlers-Danlos
syndrome.
Though not all patients require surgery, reconstruction of the ligament is particularly recommended for patients who are
very active, especially athletes involved in contact sports. Surgery can make the knee close to normal, and
permit them to return to professional sports.
When Should the Surgery
be done?
Joint Clinic- Though
the opinions vary among centers, surgery is often advised between 3 weeks and a
year following the injury. If the
surgery is carried out before 3 weeks, there is a chance that the patient may
suffer from a condition called arthrofibrosis, where excess of fibrous tissue
forms within the joint. If the surgery is delayed beyond a year, the patient
may develop damage to other structures of the knee like menisci and ligaments,
which can result in osteoarthritis.
What are the Tests
Required before Knee Surgery?
Before an
ACL reconstruction surgery is carried out, diagnosis of knee ligament injury is
confirmed based on:
·
History obtained from the patient to find out the type of injury
sustained.
·
Physical examination of the patient to look at the instability of the knee.
·
An MRI test, which
can detect injuries to ligaments and other soft tissues. During an MRI
procedure, the patient is placed inside a narrow tube, which can make them claustrophobic if they have a fear of
enclosed spaces. Few centers do offer special more open MRI machines, but the
drawback is that the pictures may not be as clear. The MRI machine makes a loud
clicking noises and it is advisable to ask for earplugs to help block these
noises out.
Other tests
had done include routine tests necessary before any arthroscopic surgery. These
include chest x-ray, ECG, blood tests to detect
your hemoglobin level, presence of infection, blood group and urine tests.
Some hospitals may want to do test for hepatitis and HIV/ AIDS, however if the patient is
not comfortable, they should discuss it with the doctor.
What is the Postoperative
Care Required following ACL Repair?
Following
ACL repair, the patient is observed for a few hours in the hospital, after
which they are discharged. A knee brace may be
used to support the knee, and the patient may be given crutches to avoid
putting direct weight on the knee. Physiotherapy is
started after a few days to strengthen the knee. Skin stitches are removed in
around a week. Full recovery may take around 6 months, after which the patient
may even be able to get back to competitive sports.
Possible complications of the procedure include:
·
Failure of graft or other devices like screws
·
Inflammation of the synovial tissue of the joint, called synovitis
·
Infection
·
Pain in the joint
·
Stiffness of the knee
·
Injury to a blood vessel or a
nerve during the surgery
·
Complications associated with anesthesia
What is the Role of
Platelet-Rich Plasma in Healing of Ligament Injuries of Knee?
Platelet-rich
plasma has been used to regenerate injured tissues. It contains a high
concentration of growth factors, which help in tissue healing. It can be
injected or placed as a gel in the knee joint following ACL reconstruction
surgery. However, the results from various clinical studies indicate a variable
response, and therefore its use currently cannot be definitely recommended.
More-
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