Our knee is supported by several ligaments which help in movement. But what happens if you tear a crucial knee ligament? Tears or 'ruptures' in ligaments of the knee are common in sportsmen and/or accident victims, especially of the anterior cruciate ligament (ACL).
Though the ACL is not the only ligament of the knee, it is one of the most crucial to maintain stability of the knee joint. Any tear of this ligament frequently leads to chronic knee instability. When a tear in this ligament happens, patients know it immediately as they report feeling or hearing a “pop” along with pain and a feeling of an unstable knee.
Types of ACL injuries
ACL injuries can be classified by the amount of damage to the ligament. They can be partial or complete tears.
- Grade I Sprain: In this there is some stretching and micro-tearing of the ACL, but it is otherwise intact. This does not require surgery.
- Grade II Sprain or partial disruption: In this there is some tearing and separation of the ligament fibres and the ligament is partially disrupted. Usually, the knee joint is also moderately unstable. Arthroscopy surgery may be required.
- Grade III Sprain or complete disruption: In this, there is total rupture of the ligament and the ligament is completely disrupted and the joint is unstable. Surgery is usually recommended for the young and active.
There are many different ways that this ligament can be reconstructed depending on the age, activity level, and gender of the patient. ACL tears can be treated using arthroscopy and minimally invasive surgical techniques.
Though non-surgical methods are available, like rehabilitation and physical therapy, they don’t help much with complete ACL tears.
1. Exercises- this helps to increase the range of motion of the injured knee, decrease the amount of swelling, and maintain muscle control.
2. Arthroscopic surgery for reconstruction of the ACL
It can be of 2 types- Repair and reconstruction of the ACL.
- A repair means that the injured ligament is left in place and the doctor tries to fix it back to the tibia or femur bones of the leg from which it has torn. This is a half-baked option as it does not restore full knee function.
- A reconstruction, on the other hand, means that the ACL is substituted by a new ligament. The surgeon creates a soft tissue “graft” and uses it to reestablish knee stability. The body populates the graft with living cells and permanently attaches it in place. And, it usually takes about 4 to 6 months for the graft to start functional like the real ACL. Reconstruction surgeries help patients to get back to the same or higher degree of activity without pain or instability. The ‘graft’ usually comes from 2 sources
- Taken from elsewhere in the patient’s body, called an autograft
- Donated by donors, called an allograft
Knee arthroscopic surgery is a minimally invasive surgery which is done using pin hole cameras and under general or local anesthesia. The torn ligament is removed and the graft is introduced in its place and secured.
Post surgery outlook
- Immediately after the surgery, the patient is placed in a brace. He or she can leave the hospital the same day if he/she wants.
- The patient has to use crutches for preventing putting weight on the operated leg.
- After-care is crucial for full functioning of the operated knee. The early postoperative period is devoted to restoring motion and decreasing swelling. After this the focus shifts to strengthening the knee joint.
- The recovery of function following an arthroscopic ACL reconstruction continues over a few months and it usually takes 2-3 months for the patient to feel normal.
As long as the operated knee is cared for properly and other injuries are avoided, the benefits of the surgery are usually permanent.
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