| ACL Reconstruction Surgery | | | | Post-Injury Exercises |
| What Is The Anterior Cruciate Ligament? | | | | As the swelling in and around the joint decreases and |
| The anterior cruciate ligament (ACL) is one of the | | | | weight-bearing progresses, mild strengthening |
| most important of four strong ligaments connecting | | | | exercises are started. |
| the bones of the knee joint. It is often injured. | | | | Quadriceps sets are one example of strengthening |
| Ligaments are strong, dense structures made of | | | | exercises at this stage. With the knee placed at |
| connective tissue that stabilize a joint. They connect | | | | approximately 10 degrees from being straight, along |
| bone to bone across the joint. | | | | with a small towel roll directly behind the knee, the |
| The function of the ACL is to provide stability to the | | | | individual pushes downward into the towel roll for a |
| knee and minimize stress across the knee joint : - | | | | count of six to 10 seconds. This is repeated 10 times. |
| - It restrains excessive forward movement of the | | | | It should be done several times throughout the day... |
| lower leg bone (the tibia) in relation to the thigh bone | | | | Bracing |
| (the femur). | | | | Bracing for the anterior cruciate ligament comes in |
| - It limits rotational movements of the knee... | | | | two forms : - |
| What Causes An ACL Tear? | | | | - Rehabilitation Brace |
| Movements of the knee that place a great strain on | | | | - Functional Brace... |
| the ACL can cause damage to the ligament. | | | | Functional or sport braces are available both |
| Hyperextension of the knee, that is, if the knee is | | | | off-the-shelf and as custom-fit. Physicians prescribe |
| straightened more than 10 degrees beyond its normal | | | | this type of brace to treat the unstable knee in |
| fully straightened position, is a very common cause | | | | people when surgery is not recommended, as well as |
| of an ACL tear. This position of the knee forces the | | | | to protect the knee in those who have had surgery.... |
| lower leg excessively forward in relation to the upper | | | | Do I Have To Have Surgery ?Treatment decisions |
| leg. | | | | for ACL tears are always individualized - tailored to |
| Pivoting injuries of the knee with excessive inward | | | | each individual. The decision whether to offer surgery |
| turning of the lower leg can also damage the ACL.... | | | | is based on the person's age, activity level, how |
| Non-Athletic-Related Injuries | | | | unstable the knee is, and whether other structures in |
| Non-sport related injuries to the ACL result from | | | | the knee have been injured... |
| similar contact and non-contact stresses on the | | | | Reconstruction Surgery For ACL Tears |
| ligament. Examples vary from being struck on the | | | | If it has been decided that you are a candidate for |
| outer side of the knee to landing on the knee forcing | | | | surgery it is important to be both mentally and |
| it into an over-straightened position with the knee | | | | physically prepared. This includes understanding the |
| turned inward.... | | | | injury, the surgery, and the rehabilitation goals.... |
| Diagnosing An ACL Tear | | | | How Is The ACL Repaired? |
| The diagnosis of an ACL tear is based on: - | | | | There are a number of different techniques available |
| A ] Physical Examination | | | | to repair a torn ACL Each surgeon has his preference |
| The physician will take a thorough history addressing | | | | for each particular situation. |
| how the injury occurred and ascertaining when the | | | | In fact we don't talk about ACL "repair" but rather |
| pain may have first appeared. Questions regarding | | | | about ACL "reconstruction." This is because a torn |
| any earlier knee injuries are important as often | | | | ACL cannot simply be repaired by sewing it together |
| ligaments and cartilage structures may have been | | | | again. This was the method tried in the early days of |
| previously strained. Any previous episodes of knee | | | | repairing ACL tears, but it was shown to be |
| instability or the knee giving way is important | | | | ineffective. Thus, newer methods were developed |
| information. | | | | which involve reconstructing the ACL ligament, |
| B ] Radiographic Evaluation | | | | including substituting a new ligament for the damaged |
| Acute knee injuries generally warrant x-ray films. | | | | one. Using tendons from other parts of the body as |
| They are carefully evaluated for any possible tearing | | | | a substitute for the ACL was found to be the most |
| away of bone where the ligaments attach. Also, the | | | | effective way of reconstructing the torn ACL. |
| x-ray will show any loose bone fragments or other | | | | Currently, the two most popular methods in use are |
| fractures if they are present. | | | | using part of the patella tendon or using a hamstring |
| C ] MRI | | | | muscle tendon... |
| Magnetic resonance imaging is a noninvasive test that | | | | There are several available operative procedures : - |
| produces an excellent image of all parts of the knee. | | | | A ] Patellar tendon graft procedure |
| In this test, the individual lies in a hollow cylinder while | | | | Since it was popularized in the mid-1980s, the patellar |
| powerful magnets create signals from inside the | | | | tendon graft has been the "gold standard" choice for |
| knee. These signals are then converted into a | | | | ACL reconstruction. This type of ACL replacement |
| computer image that clearly shows any damage to | | | | uses the middle third of the person's own patella |
| the structures inside the joint. | | | | tendon and is referred to as a bone-tendon-bone |
| D ] KT 1000 | | | | (BTB) graft.... |
| An instrument called the KT 1000 is a device that can | | | | B ] Hamstring graft procedure |
| give information about the integrity of the ACL. It | | | | Hamstring reconstruction is an alternative to the |
| allows the or therapist to measure the amount of | | | | bone-patellar-bone graft fixation and is growing in |
| forward motion of the lower leg in relation to the | | | | popularity. In this procedure, rather than using the |
| upper leg. It is used frequently. Both knees are | | | | patellar tendon, the surgeon uses the patient's own |
| usually tested and then compared. This device also | | | | hamstring tendon, either the semitendinosus or gracilis |
| accurately measures the amount of backward | | | | tendons from the same leg.... |
| movement of the knee joint.... | | | | C ] Allograft procedure |
| What Can Be Done For An ACL Tear? | | | | Another option is the use of tissue from a cadaver |
| The initial goals of treatment immediately after injury | | | | (a deceased person) called an allograft. |
| are to reduce pain and swelling and regain range of | | | | Patellar tendon, hamstring tendon, or achilles tendon |
| motion and strength. Even if the surgery is likely, | | | | allografts can be used as tissues inserted and fixed |
| achieving as much knee motion and strength as | | | | with the same techniques that are used for |
| possible can greatly reduce complications after | | | | autografts (grafts using the individual's own tissue)... |
| surgery... | | | | Synthetic grafts |
| Immediately after the injury | | | | Synthetic grafts (i.e., grafts made from other |
| The physician may request very gradual | | | | materials) were commonly used in the 1970s but |
| weight-bearing exercise immediately after the initial | | | | were generally unsuccessful. |
| ACL injury. Braces used early after the injury are | | | | There are currently no synthetic ligaments in the U.S. |
| called rehabilitation kneebraces and are off-the-shelf | | | | approved by the FDA for primary ACL |
| designs used for conservative treatment of the | | | | reconstruction.... |
| ligament tear.... | | | | |