Arthroscopic ACL Reconstruction & Multi Ligament Surgery
Arthroscopic ACL Reconstruction
The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope like structure located in the centre of the knee running from the femur to the tibia. When this ligament tears unfortunately, it does not heal and often leads to the feeling of instability in the knee.
ACL reconstruction is a commonly performed surgical procedure and with recent advances in arthroscopic surgery can now be performed with minimal incision and low complication rates.
The advancements in arthroscopic surgery make it easy for surgeons to see and work on knee structures through small incisions. Repair of the torn ligament can be performed at the same time as the diagnostic arthroscopy with fewer surgical risks.
The surgery can usually be done as an outpatient procedure which means you may be discharged to go home on the same day as the procedure.
ACL Reconstruction Hamstring Tendon
Anterior cruciate ligament (ACL) reconstruction hamstring method is a surgical procedure that replaces the injured ACL with a hamstring tendon. Anterior cruciate ligament is one of the four major ligaments of the knee that connects the femur (thigh bone) to the tibia (shin bone) and helps stabilize your knee joint. Anterior cruciate ligament prevents excessive forward movement of the lower leg bone (the tibia) in relation to the thigh bone (the femur) as well as limits rotational movements of the knee.
A tear of this ligament can make you feel as though your knees will not allow you to move or even hold you up. Anterior cruciate ligament reconstruction is surgery to reconstruct the torn ligament of your knee with a tissue graft.
Causes
An ACL injury most commonly occurs during sports that involve twisting or overextending your knee. An ACL can be injured in several ways:
- Sudden directional change
- Slowing down while running
- Landing from a jump incorrectly
- Direct blow to the side of your knee, such as during a football tackle
Symptoms
When you injure your ACL, you might hear a loud "pop" sound and you may feel the knee buckle. Within a few hours after an ACL injury, your knee may swell due to bleeding from vessels within the torn ligament. You may notice that the knee feels unstable or seems to give way, especially when trying to change direction on the knee.
Diagnosis
An ACL injury can be diagnosed with a thorough physical examination of the knee and diagnostic tests such as X-rays, MRI scans and arthroscopy. X-rays may be needed to rule out any fractures. In addition, your doctor will often perform the Lachman’s test to see if the ACL is intact. During a Lachman test, knees with a torn ACL may show increased forward movement of the tibia and a soft or mushy endpoint compared to a healthy knee.
Pivot shift test is another test to assess ACL tear. During this test, if the ACL is torn, the tibia will move forward when the knee is completely straight and as the knee bends past 30° the tibia shifts back into correct place in relation to the femur.
Procedure
The goal of ACL reconstruction surgery is to tighten your knee and to restore its stability.
Anterior cruciate ligament reconstruction hamstring method is a surgical procedure to replace the torn ACL with part of the hamstring tendon taken from the patient’s leg. The Hamstring is the muscle located on the back of your thigh. The procedure is performed under general anaesthesia. Your surgeon will make two small cuts about 1/4-inch-long around your knee. An arthroscope, a tube with a small video camera on the end is inserted through one incision to see the inside of the knee joint. Along with the arthroscope, a sterile solution is pumped into the joint to expand it enabling the surgeon to have a clear view and space to work inside the joint. The knee is bent at right angles and the hamstring tendons felt. A small incision is made over the hamstring tendon attachment to the tibia and the two tendons are stripped off the muscle and the graft is prepared. The torn ACL will be removed and the pathway for the new ACL is prepared. The arthroscope is reinserted into the knee joint through one of the small incisions. Small holes are drilled into the upper and lower leg bones where these bones come together at the knee joint. The holes’ form tunnels in your bone to accept the new graft. Then the graft is pulled through the predrilled holes in the tibia and femur. The new tendon is then fixed into the bone with screws to hold it into place while the ligament heals into the bone. The incisions are then closed with sutures and a dressing is placed.
Risks & Complications
Possible risks and complications associated with ACL reconstruction with hamstring method include:
- Numbness
- Infection
- Blood clots (Deep vein thrombosis)
- Nerve and blood vessel damage
- Failure of the graft
- Loosening of the graft
- Decreased range of motion
- Crepitus (crackling or grating feeling of the kneecap)
- Pain in the knee
- Repeat injury to the graft
Post-operative Care
Following the surgery, rehabilitation begins immediately. A physical therapist will teach you specific exercises to be performed to strengthen your leg and restore knee movement. Avoid competitive sports for 5 to 6 months to allow the new graft to incorporate into the knee joint.
Anterior cruciate ligament reconstruction is a very common and successful procedure. It is usually indicated in patients wishing to return to an active lifestyle especially those wishing to play sports involving running and twisting. Anterior cruciate ligament injury is a common knee ligament injury. If you have injured your ACL, surgery may be needed to regain full function of your knee.
ACL Reconstruction Patellar Tendon
Anterior cruciate ligament (ACL) reconstruction patellar tendon is a surgical procedure that replaces the injured ACL with a patellar tendon. Anterior cruciate ligament is one of the four major ligaments of the knee that connects the femur (thigh bone) to the tibia (shin bone) and helps stabilize the knee joint. Anterior cruciate ligament prevents excessive forward movement of the lower leg bone (tibia) in relation to the thigh bone (femur) as well as limits rotational movements of the knee.
A tear of this ligament can make you feel as though your knees will not allow you to move or even hold you up. Anterior cruciate ligament reconstruction is surgery to reconstruct the torn ligament of your knee with a tissue graft.
Causes
An ACL injury most commonly occurs during sports that involve twisting or overextending your knee. The ACL can be injured in several ways:
- Sudden directional change
- Slowing down while running
- Landing from a jump incorrectly
- Direct blow to the side of your knee, such as during a football tackle
Symptoms
When you injure your ACL, you might hear a loud "pop" sound and you may feel the knee buckle. Within a few hours after an ACL injury, your knee may swell due to bleeding from vessels within the torn ligament. You may notice that the knee feels unstable or seems to give way, especially when trying to change direction on the knee.
Diagnosis
An ACL injury can be diagnosed with a thorough physical examination of the knee and diagnostic tests such as X-rays, MRI scans and arthroscopy. X-rays may be needed to rule out any fractures.
In addition, your doctor will often perform the Lachman’s test to see if the ACL is intact. During a Lachman test, knees with a torn ACL may show increased forward movement of the tibia and a soft or mushy endpoint compared to a healthy knee.
Pivot shift test is another test to assess ACL tear. During the pivot shift test, if the ACL is torn the tibia will move forward when the knee is completely straight and as the knee bends past 30° the tibia shifts back into correct place in relation to the femur.
Procedure
The goal of ACL reconstruction surgery is to tighten your knee and to restore its stability.
Anterior cruciate ligament reconstruction patellar tendon is a surgical procedure to replace the torn ACL with part of the patellar tendon taken from the patient’s leg. The new ACL is harvested from the patellar tendon that connects the bottom of the kneecap (patella) to the top of the shinbone (tibia). The procedure is performed under general anaesthesia. Your surgeon will make two small cuts about ¼ inch around your knee. An arthroscope, a tube with a small video camera on the end is inserted through one incision to see the inside of the knee joint. Along with the arthroscope, a sterile solution is pumped into the knee to expand it providing the surgeon a clear view of the inside of the joint. The torn ACL will be removed and the pathway for the new ACL is prepared. Your surgeon makes an incision over the patellar tendon and takes out the middle third of the patellar tendon, along with small plugs of bone where it is attached on each end. The remaining portions of the patellar tendon on either side of the graft are sutured back after its removal. Then the incision is closed. The arthroscope is reinserted into the knee joint through one of the small incisions. Small holes are drilled into the upper and lower leg bones where these bones come together at the knee joint. The holes’ form tunnels in your bone to accept the new graft. Then the graft is pulled through the predrilled holes in the tibia and femur. The new tendon is then fixed into the bone with screws to hold it into place while the ligament heals into the bone. The incisions are then closed with sutures and a dressing is placed.
Risks & Complications
Possible risks and complications associated with ACL reconstruction with patellar tendon method include:
- Numbness
- Infection
- Blood clots (Deep vein thrombosis)
- Nerve and blood vessel damage
- Failure of the graft
- Loosening of the graft
- Decreased range of motion
- Crepitus (crackling or grating feeling of the kneecap)
- Pain in the knee
- Repeat injury to the graft
Post-operative Care
Following the surgery rehabilitation begins immediately. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement. Avoid competitive sports for 5 to 6 months to allow the new graft to incorporate into the knee joint.
Anterior cruciate ligament reconstruction is a very common and successful procedure. It is usually indicated in patients who desire to return to an active lifestyle especially those wishing to play sports involving running and twisting. Anterior cruciate ligament injury is a common knee ligament injury. If you have injured your anterior cruciate ligament, surgery may be needed to regain full function of your knee.
Multi Ligament Knee Reconstruction
Ligaments are fibrous tissue bands that connect bones and stabilize joints. The knee joint has four major ligaments – the anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament, and medial collateral ligament.
A multi-ligament knee injury involves injury to two or more ligaments of the knee. These injuries are usually high energy in nature such as motor vehicle accidents, severe fall from height, or during sports such as skiing and football.
Multi ligament knee injury requires reconstruction surgery to rebuild the damaged tissues and prevent problems associated with an unstable knee such as premature osteoarthritis.
Symptoms
Patients with multi-ligament knee injuries may experience pain, swelling, limited range of motion, injuries to nerves and arteries of the leg, and knee instability.
Diagnosis
The main problem in diagnosing patients with multiple ligament tears is to accurately detect which ligaments are torn, and the extent of the tears.
The diagnosis starts with a comprehensive clinical evaluation by an orthopaedic surgeon.
The main imaging techniques which are employed for the diagnosis are knee X-rays and MRI scan of the joint.
In addition, functional testing can be performed during an arthroscopic examination, before the surgical reconstruction, to help confirm the results of the diagnosis. This testing includes tests such as “gap test” which measures the space between the femur and tibia.
Contraindications for reconstructive knee surgery include previous knee joint infection, reflex sympathetic dystrophy, complex regional pain syndrome, and morbid obesity.
Procedure
During Multiligament Knee Reconstruction surgery, ligaments are reconstructed using a graft taken from the patient (autograft) or donor tissue (allograft).
Surgical reconstruction is usually performed arthroscopically through tiny incisions with the use of an arthroscope and small surgical instruments. Your surgeon will create a tunnel in the thigh and tibia bone using a small drill. Your surgeon then inserts the grafts into the tunnel to replace the torn ligaments.
After the grafts are placed, fixation devices are used to secure the grafts and hold the ligament in place until healing occurs.
Post-operative Care
Physical therapy is recommended for restoration of the normal knee motion and muscle strength which avoids complications and also prolonged course of rehabilitation is recommended after surgery.
After multi-ligament knee reconstruction, crutches may be required for 6 to 8 weeks.
Risks & Complications
Unfortunately, there can be failure of ligament reconstruction surgery, to restore normal stability of the knee joint. Reasons for such failure may be due to errors in surgical techniques, failure of graft integration, inadequate rehabilitation, post operative infection, and traumatic re injury.