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Knee — Anterior Cruciate Ligament Reconstruction for Raleigh, Durham, Garner, Wake Forest and Triangle

The anterior cruciate ligament (ACL) is one of the major stabilizing ligaments in the knee. It is a strong non-elastic structure located in the center of the knee running from the femur to the tibia.

The anterior cruciate ligament prevents the femur from moving backward and twisting abnormally on the tibia. The anterior cruciate ligament is required for normal function of the knee. One of the main functions of the ACL is to provide stability during rotational movements such as turning, twisting and cutting maneuvers.

A ruptured anterior cruciate ligament does not heal itself and the knee may become unstable or give way. Repeated giving way can lead to damage of other structures of the knee and eventually advanced arthritis. Since the knee 'dislocates' when the ligament ruptures there is often damage to other structures in the knee such as bone, cartilage or meniscus. These injuries may also need to be addressed at the time of surgery.

Description of ACL injuries

Normally, ACL injuries are of a significant nature and involve a twisting force to the knee. It can also occur after landing from a jump, stopping rapidly or direct contact such as in a tackle. It is particularly common in sports such as football, soccer, basketball, volleyball and skiing.

When the anterior cruciate ligament ruptures the patient often experiences a "giving way" sensation in the knee or hears a "pop". Most people cannot continue with their activity and the knee generally swells within hours.

Initial Management of ACL injuries in
Raleigh, Durham, Apex and the Triangle

The knee should be treated with ice, elevation and a compressive bandage .Crutches and analgesics usually are required. An X-ray is necessary to exclude an associated fracture. Physical therapy is helpful to reduce swelling and regain motion.

Most patients will be referred to an orthopaedic surgeon for diagnosis and assessment of the injury for potential ACL reconstruction. Careful clinical examination is required to detect damage to the ACL as well as other ligaments and structures in the knee such as the meniscus or articular cartilage. It is quite common to damage some of these other structures.

Diagnosis to Evaluate Potential ACL Reconstruction

This can usually be made on history and clinical examination. An MRI scan which is a special imaging test is often ordered to confirm the diagnosis in patients where the examination is not conclusive. It also demonstrates damage to other structures such as the menisci or articular cartilage. The diagnosis can also be made with an arthroscopy.

Treatment Recommendations

Most patients who tear their ACL during sport will elect to have ACL reconstruction to enable them to return to full activities with a stable, normally functioning knee. Some patients choose to modify their activities and give up sport to avoid further episodes of instability or wear a brace.

In general, the younger and more active you are then the stronger the recommendation for reconstruction. It is generally recommended to have surgery if you wish to get back to sports which involve twisting and pivoting. Many patients who do not have surgery find that their knee becomes increasingly unstable over time. This can lead to a knee that gives way during ordinary activities of daily living. These patients should strongly consider surgery to stabilize the knee.

Repeated instability or abnormal movement in the knee can cause ongoing damage leading to stretching of other structures around the knee, meniscal tears or arthritis. If you do not elect to have surgery it is strongly advised that you give up sports that involve pivoting, cutting or rotation.

It is also recommend that people with dangerous occupations such as policemen, firemen, roof tilers and scaffolders have surgery. This is a safety issue to prevent instability in 'at risk' situations.

There is no urgency in performing this operation and in fact it is sometimes better to allow the knee to overcome the initial injury and regain close to full motion prior to surgery. Your surgeon will advise you on the timing in your particular case.

Pre-Op Instructions

Discontinue aspirin and anti-inflammatory medications (e.g., voltaren, feldene) 10 days prior to surgery as they can cause bleeding. Cease any naturopathic or herbal medications 10 days before surgery as these can also cause bleeding. Continue with all other medications unless otherwise specified. Notify your surgeon if you have any abrasions or other wounds to the knee. Please bring any X-Rays, MRI scans or other diagnostic testing results you have had done which may be relevant to your surgery.

Our surgery scheduling coordinators will advise you of all additional requests and steps to take prior to your surgery date. If you smoke, you are advised to stop smoking for as long as possible prior to surgery.

After Surgery

During surgery local anaesthetic is injected into the knee to reduce the amount of pain you will feel. Pain relieving medication will be provided for you both at the surgery center and at home. You will have a dressing on your wound and a compressive wrap.

Most patients go home the the same day.

Your dressing should be left intact until your first postoperative physical therapy visit.

Ice packs or a cooling unit should be used regularly to reduce swelling. Your graft is strong enough to put all your weight on your operated leg. You can walk around but rest as much as possible for the first week and elevate your leg when sitting. Most patients require crutches for a week or so. Pain is variable and prescription pain killers may be required for a week or two.

You may shower but not bathe or swim prior to your post operative visit. It is normal to have blood under the dressing. If there is excessive ooze the dressings can be changed by someone experienced in wound care. If concerned please contact your surgeon.

You will follow up with your surgeon approximately one week to 10 days after surgery. During that time you will start your physical therapy regimen.

If there is any redness, increased swelling or you are running a noticeable fever you should contact the practice to discuss with the surgeon.

Time off work depends on your work requirements and is extremely variable. Office workers usually require 1-2 weeks off work and manual labourers 2 to 3 months or longer.

Rehabilitation

Physical Therapy is an integral part of the treatment and is recommended to start as early as possible. Preoperative therapy is helpful to better prepare the knee for surgery. The early aim is to regain range of motion, reduce swelling and achieve full weight bearing.

The remaining rehabilitation will be supervised by a physical therapist and will consist of progressive activities such as exercise bike riding, swimming, proprioceptive exercises and muscle strengthening. Light cycling can begin at 2-3 weeks, jogging can generally begin at around 2-3 months. The graft is strong enough to allow sport at around 6 months however other factors come into play such as confidence, fitness and adequate skills training.

Professional athletes often return at 6 months but recreational athletes may take 10 -12 months depending on motivation and time put into rehabilitation.

The rehabilitation and overall success of the procedure can be affected by associated injuries to the knee such as damage to meniscus, articular cartilage or other ligaments.

Complications

Despite advances in surgical technique and the utmost care being taken during surgery, complications can still occur. It is very important for patients undergoing this operation to understand the reasons for the procedure and to have a major role in making an informed choice to proceed with surgery rather than non surgical treatment.
 

Conclusion

In general this procedure is very successful but complications can occur with any surgical procedure. Other rare or unexpected complications can occur. This is an elective procedure and as the patient you need to make an informed decision on whether or not to proceed with surgery.

For more information on how the ACL reconstruction specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!

Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC.