Anterior Cruciate Ligament Reconstruction Treatments
What is the initial treatment of ACL injury?
The initial management focusses on decreasing knee swelling and restoring knee range of motion, improving stability and restoring function.
In isolated ACL injuries, weight bearing is usually allowed without crutches, but they may be required for stability or when there is associated injury of other knee structures. Knee swelling is managed with ice packs, supportive braces and compression stocking if tolerated. Physiotherapy is a great initial management modality to regain range of motion and restore gait and normal weight bearing. Physiotherapy also help re-activate the hamstring and quadriceps muscles, especially the VMO (vastus medialis obliquus) component which is important in the final stages of knee extension.
In some cases, the knee becomes stable and function is restored with physiotherapy and the use of a supportive brace, especially during activities that place increased rotational forces on the knee.
In these cases surgery may not be required, but if the patient continues to experience knee instability, swelling, pain or is unable to return to desired activities at work, leisure or during daily living then surgical treatment is possible with ACL reconstruction.
What is ACL reconstruction surgery?
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 surgery uses arthroscopic assistance to prepare the joint and to address any other injuries like meniscal tears which may be trimmed or repaired first. A tendon graft is required for the reconstruction. Most commonly, this is obtained by harvesting two of the patient’s smaller hamstring muscles. Other sources of tendon graft are the central portion of the patella tendon with a piece of bone on either end. The graft is secured in both sides of the tunnel and becomes the reconstructed ACL.
What is rehabilitation like after ACL reconstruction?
Rehabilitation after ACL reconstruction is a lengthy process and takes many months after surgery. Initial recovery after surgery includes physiotherapy to reduce swelling, reactivate the quadriceps and hamstring muscle and restore a normal pattern of weight bearing.
Strengthening exercises gradually commence followed by walking at pace, stationary bike exercises, jogging and eventually running. These activities progress over months and you will be guided by your physiotherapist. Dr Khatib has a recommended timeline for rehabilitation after ACL reconstruction which you can download and take to your physiotherapist.
Anterior Cruciate Ligament
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