Definition:
- ACLS or Anterior cruciate ligament (ACL) surgery is performed to either reconstruct or repair the torn ACL. The anterior cruciate ligament is situated in the center of the knee joint. It extends from the femur to the tibia.
- The surgery needs to be performed mostly in the cases of an avulsion fracture and in most cases the auto grafts are used to replace the ligament during the surgery. The surgery is performed arthroscopically.
Details of Procedure:
- Normally ACL gets injured when a twisting force is applied to the knee while the foot is firmly put on the ground or due to direct blow to the knee while playing foot ball or rugby
- The aim of the surgery is to restore the normal or almost normal stability and function of the injured knee. Surgery also saves the other knee structure from injury and degeneration.The surgery is advised to repair a complete or partial tear of the ACL, when there is:
- No improvement in instability of knee with non surgical treatment and after rehabilitation program
- An active sportsman, or a person’s work requires enough knee strength and stability
- Chronic ACL deficiency, affecting quality of life
Symptoms of a torn ACL:
- Severe pain at the knee soon after the injury and /or an audible pop or crack sound
- Sudden feeling of instability followed by huge swelling of the knee
- Loss of strength with restricted movement and difficulty in straightening the leg fully
- Mild tenderness around the injured area
- Positive signs in the anterior drawer test and Lachman’s test.
Facts and Figures:
- According to a published data 1 person per 3000 individuals in United States had anterior cruciate ligament injury and total 100,00 injuries per year occurs from snow skiing.
- Female athletes are prone to get more ACL tear than male sports persons.
- The first information and discussion about ACL injury in medical literature is done by Bonnet in 1845.
Advantages and Disadvantages:
Advantages
- High success rate- About 60% of patients returns to normal work after undergoing the ACL surgery and about 80 to 90 % of patients are satisfied with the out come of the surgery
- Patients seeking and anterior cruciate ligament repair through medical tourism can return home within 1-2 days in most cases.
- No need for long hospital stay, as ACL repair is done arthroscopically.
Disadvantages
- Improper healing may cause the need for revision ACL reconstruction
- Limited exercises of thigh muscles post surgery for some time.
- Post operative stiffness with limited mobility of knee.
Pre-operative and Post-operative care:
Pre-operative preparation:
- Complete physical examination
- Blood and urinalysis
- ECG and x-ray chest for patient above 50 years of age
- Consultation with surgeon or doctor a week ago, and have a list of medicine which is to be taken or needed to be stopped. Inform the surgeon about habit of smoking and alcohol.
- Visit to physical therapist for proper understanding of post-operative rehabilitation
- Have an arrangements with family and/or friends to help during the post-operative rehabilitation
- Do not eat or drink anything after midnight the night before surgery
Post-operative care:
- After the surgery a continuous passive motion device may be applied to the patients that need to be used while sleeping for the first two weeks.
- The physical therapy is started from the 2nd or 3rd day after the surgery. It is important to follow the rehabilitation program rigidly to have a good outcome from the surgery.