ACL tear is one of the most common injuries sportspersons have to bear. As knee ligaments are essential for functioning, ligament tear can affect the knee joint. Out of all the ligaments, the Anterior Cruciate Ligament (ACL) is the major ligament. To repair or reconstruct the broken ACL, knee ligament tear surgery is conducted.
Most of the knee injuries majorly occur in sports; it is also seen when an individual’s knee is twisted or the knee takes a direct hit. In common terminology, an ACL tear is also called a knee popped out or bone moved. At Santokh Hospital, we help sportspersons continue training and performing at their best with advanced ACL knee surgery for a torn ACL.
What is ACL and How Does it Tear?
Three bones form the knee joint (thighbone, shinbone, and kneecap). These bones are connected through ligaments, and we have four ligaments in the knee. Consider these ligaments as strong ropes that hold the knee bones together and keep them stable.
The ACL is one of the ligaments that runs crisscross with the PCL (Posterior Cruciate Ligament). These two ligaments control the knee’s front and back motion. Moreover, the ACL also prevents the tibia (shinbone) from sliding out while providing rotational stability.
Some of the causes for an ACL tear are:
- Changing knee direction rapidly.
- Running and then stopping suddenly causes a jolt to the ligament.
- Landing on the ground from a jump improperly.
- Collision, accident, or direct content with a hard substance.
ACL tears are the most common sports persons because of the nature of their games and the pressure it exert on the body.
Symptoms of Torn Ligament (ACL Injuries)
When the ACL tears, there is a popping sound. However, given the circumstances in which an ACL is torn, hearing the sound is difficult. Hence, you need to look for other symptoms, including;
- Within 24 hours, the knee will swell, and there will be pain. Don’t ignore this pain, as it can aggravate if not checked.
- The range of knee motion will be limited.
- If you notice along the joint line, there might be tenderness.
- Difficulty in walking
It can happen that these symptoms exist together or separately. Hence, at the first sign of any of these symptoms, consult a doctor.
ACL Knee Ligament Tear Surgery | Diagnosis and Treatment
In the majority of the cases, knee ligament surgery is required. A knee ligament surgery is different from a knee surgery. The latter includes replacing the bones in the knee with a metal or plastic-based attachment. Only very minor tears and sprains can heal with non-surgical treatments and medication. Even then, there is a higher risk of ACL injuries as it has already become weak with minor tears and sprains.
Diagnosing the ACL Injury
To diagnose an ACL injury, orthopedics start by performing a physical exam of the knee to check for ACL tear symptoms. After initial analysis, the patient might be asked to take imaging tests like CT Scan, MRI, X-ray, and Ultrasound.
These tests are done to assess knee health and bone health, to see the soft tissues, and to get 3D detailed images of the bones. From there, the doctors are able to confirm the injury and assess the amount of damage done to the ligaments and bones. As a result, they can plan the requisite knee ligament tear reconstructive surgery.
If other issues and ACL injuries are diagnosed, they can be treated through the injury as well. In addition to the tests above, some doctors want to get a more detailed analysis of ACL tears with other tests. Two tests can be performed on the patient to determine whether the ACL tear is complete or partial.
- Lachman Test: The shin bone is pulled away from the thigh bone. In case the ACL is torn but still intact with the bones, the latter may not move or move slightly.
- Pivot Shift Test: With the patient lying on their back, the doctor will lift their legs to place rotational pressure. If the bones shift, it means the ACL is torn, but if they don’t, then the ACL might be partially affected.
Treatment – Knee Ligament Operation
The knee ligament tear surgery repairs a torn ligament, and there are different methods to do the same. Surgeons have two options and can choose one depending on the situation.
Before we discuss that, let’s know what happens in an ACL knee surgery or Arthroscopy.
- In arthroscopy, the surgeons insert a medical device in the knee called an arthroscope. This thin and flexible tube has thin fiber-optic cables, which work as a light source and a camera for the surgeons.
- A small incision is required to insert the arthroscope, and additional small incisions are made to insert other medical instruments. These instruments are required to remove the torn ligament and reconstruct the ACL.
- As the arthroscope lights up the insides of the knee, the surgeons depend on the camera output to conduct the operation. A tunnel is constructed into the bone to pass the new tissue and join it to the bones.
- Surgeons attach the ligament tissue in the same place where the old ACL has been torn or damaged. These tissues are held into place with the help of screws or staples.
For grafting new tissue to replace the old, the surgeons have two major options.
Autografting in knee ligament tear surgery is when the ligament is repaired from a tissue graft from the patient’s own body. In other words, the surgeons take living tissue from the patient’s hamstring or kneecap (knee joint) and insert it into place for ACL reconstructive surgery.
It can take a long time for the patient to recover after autografting; however, it is more stable and less likely to re-tear.
This type of replacement tissue is when the tissues to replace the ligament are taken from a donor. This procedure is less painful for the patient, but this form of tissue grafting is less stable.
Surgeons don’t recommend allograft for more active sportspeople who play highly competitive and straining sports. It takes relatively less time for the patient to recover after an allograft.
There is another option for tissue grafting, wherein surgeons can use synthetic grafts. Until now, the silver and silk fibers were used for replacing the damaged and torn ACL. But, new material is being tested and available, like carbon fiber and Teflon. However, scientists are looking for other more stable and stronger material for tissue grafting.
Recovery Time and Procedure After ACL Knee Ligament Operation
It can take up to one year to fully recover after the knee ligament tear surgery. Before discharging the patient, the doctors recommend the patients to follow a set routine. Even after the operation, the affected area might have mild bruising, swelling, pain, and redness. However, these symptoms are temporary and can only last for about one week.
As the rehabilitation begins, the patients are provided with a well-structured rehabilitation program by their doctors;
- For the first couple of weeks, there should be zero to negligible movement. Painkillers are prescribed, and the patients can be given cryo or cuff to for pain management and to reduce the swelling.
- Minimal exercises and movement shall begin from the second week after the operation. The exercises are simple, like fully extending and bending the knee, exercises for strengthening the leg muscles, improving balance, and walking properly. By the third week, it will be possible to walk without crutches.
- Until 6 months from the date of operation, the patient will regain the strength to perform all the normal activities. However, still playing sports and performing activities with a lot of twisting and turning is not recommended.
- After 6 months, it will be possible and safe to play sports. But now, the challenge is to be prepared mentally and gain the same confidence as before. Initially, it won’t be easy to get back to the same level of the game, but it will get better as long as there are no additional ACL injuries.
Throughout the recovery period, exercises that help regain muscle strength and maintain balance must continue. Medication might continue for a longer period of time, depending on the quantum of damage and the recovery schedule. Orthopedic surgeons can choose between an arthroscopic surgery or an open surgery, but the former is less invasive and has proven results with quicker recovery.
The ACL is one of the main ligaments holding the knee bones together. While it maintains knee activity, a torn ligament can be a painful experience. With the amount of strenuous activity done by sportspeople while training or playing, ACL injuries have become common. Out of all the methods, an ACL knee ligament tear surgery is the best course of action.
At Santokh Hospital, we have an experienced and well-renowned team of orthopedic surgeons to conduct knee ligament surgery. Schedule an appointment today to get a comprehensive analysis of your knee health and get effective treatment.