Dr. Dharmapal G. K. The Best Orthopaedic Surgeon in Bengaluru

Treatment for Anterior Cruciate Ligament (ACL) Injuries

Suffering from knee pain

TREATMENT

Treatment for an ACL tear will vary depending upon the patient’s individual needs. For example, the young athlete involved in agility sports will most likely require surgery to safely return to sports. The less active, usually older, individual may be able to return to a quieter lifestyle without surgery.

Nonsurgical Treatment

A torn ACL will not heal without surgery. But nonsurgical treatment may be effective for patients who are elderly or have a very low activity level. If the overall stability of the knee is intact, your doctor may recommend simple, nonsurgical options.

Bracing. Your doctor may recommend a brace to protect your knee from instability. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.

Physical therapy. As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it.

Surgical Treatment

Rebuilding the ligament. Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament must be reconstructed. Your doctor will replace your torn ligament with a tissue graft. This graft acts as a scaffolding for a new ligament to grow on.

Grafts can be obtained from several sources. Often they are taken from the patellar tendon, which runs between the kneecap and the shinbone. Hamstring tendons at the back of the thigh are a common source of grafts. Sometimes a quadriceps tendon, which runs from the kneecap into the thigh, is used. Finally, cadaver graft (allograft) can be used.

There are advantages and disadvantages to all graft sources. You should discuss graft choices with your own orthopaedic surgeon to help determine which is best for you.

Because the regrowth takes time, it may be six months or more before an athlete can return to sports after surgery.

Procedure. Surgery to rebuild an anterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic surgery is less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times.

Rehabilitation

Whether your treatment involves surgery or not, rehabilitation plays a vital role in getting you back to your daily activities. A physical therapy program will help you regain knee strength and motion.

If you have surgery, physical therapy first focuses on returning motion to the joint and surrounding muscles. This is followed by a strengthening program designed to protect the new ligament. This strengthening gradually increases the stress across the ligament. The final phase of rehabilitation is aimed at a functional return tailored for the athlete’s sport.

FAQ

ACL [anterior cruciate ligament] is an important knee joint stabilizing structure which bridges the thigh bone and shin bone.

It is basically a sports related injury which happens in contact sports like football, basketball, kabaddi and also it is commonly seen in bike related accidents.

ACL along with providing stability to the knee, protects menisci and articular cartilage from damages thereby preventing osteoarthritis.

ACL does not heal by itself because of lack of blood supply.

Knee instability, occasional pain, loss of quadriceps strength.

In an ideal situation like young and active patients, arthroscopic ACL reconstruction surgery is the answer. But in middle aged individual with less active lifestyle and with preexisting arthritis of knee joint it can be managed conservatively

Obviously yes, of course age is just a number, studies have shown successful results are even achieved in 60 yr. old patients.

Untreated and symptomatic ACL tears lead to secondary meniscal tears and cartilage damages which will progress to osteoarthritis.

It depends on the percentage of ligament involved and the kind of physical demand the patient has.

There are conflicting debates, in our hands early ACL reconstructions have given good results. Also, in coexisting pathologies like meniscus tears, cartilage injuries, multi ligament knee injuries earlier the better.

All the patients will be guided through a customized physiotherapy program to achieve excellent results which will be started at the earliest.

Generally, the following day after surgery with crutch assistance for upto 3 weeks. Beyond 3 weeks patient can walk without assistance.

After diagnostic arthroscopy, torn ACL is debrided, anatomical tunnels are created in femur [thigh bone] and tibia [shin bone] to receive the prepared graft tissue and will be secured in the bony tunnels with implant devices in both the ends of femur and tibia

Commonly hamstring tendon and bone patellar tendon is used, also quadriceps tendon, peroneus longus tendon can be used depending on the co-existing ligament injuries.

Anatomical single bundle ACL reconstruction, Double bundle ACL reconstruction, All-Inside ACL reconstruction are possibilities as of today.

ACL repair is a revived concept of earlier times. With improved technology and proper case selection as in young patients, femoral peel offs and bony avulsion if done in 3 weeks of time we can expect good results.

In case of sitting job – 2 weeks, Jobs which demands walking – 4 to 6 weeks.

For a non-contact sport like badminton, table tennis it is about 4 months.

Jogging in 4 months,

Contact sports like football, basketball, cricket in 6 months.

Yes, with adequate conditioning programs, sports specific approach.

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