arthroscopic acl reconstruction

Medically Reviewed By : Dr Sravya, MBBS, MS

Introduction

What is ACL Injury?

One of the four main knee ligaments is the anterior cruciate ligament (ACL). It aids in maintaining the knee’s stability and appropriate motion. Anterior cruciate ligament (ACL) tears or ruptures are the most frequent knee injuries. ACL damage is often treated with arthroscopic ACL reconstruction.

An ACL injury frequently starts with a “pop “in the knee and is followed by pain and edema. When patients begin walking and other activities, they could also have knee instability because the ligament’s ability to support the knee joint stops and the tibia from sliding forward has worn out.

There are three grades for ACL injuries: 1, 2, and 3. Depending on the extent of the ACL damage, the patient’s age, and level of athleticism, non-operative or surgical treatments may be advised.

In order to restore function after an injury, a procedure known as anterior cruciate ligament restoration (ACL reconstruction) involves replacing the anterior cruciate
ligament, which is found in the knee, using tissue grafts. The most common scenario for performing arthroscopic ACL repair surgery is when the ligament has avulsed— broken off from the bone—but is still intact. The ligament is stabilised and reattached to the bone.
In cases where the ligament has ripped partially, repair is occasionally done. In order for the ligament to mend, the surgeon must sew it back together. Instead of ACL,reconstruction, this method entails restoring it by reattaching it. Faster healing and the absence of donor site morbidity are theoretical benefits of repair, but there are no randomised controlled trials or long-term data on re-rupture rates utilising modern surgical procedures.

In This Article

Symptoms of acl injury

A “popping” sound that happens when the ACL is ruptured or pressured is a crucial indicator of an ACL injury in addition to severe pain.

The following are some signs of an ACL injury

pain
swelling
Having trouble or being unable to extend your knee
inconvenience when walking
knee pain in the area
a lack of ability to bear weight on a leg
a sense that the knee could give way

Causes of acl injury

Although an ACL injury can occur at any age and fitness level, it typically does so during activity and in association with:

abrupt halt, direction changes, or stops while travelling.
a knee injury, especially one that comes from the side.
extending the knee too far.
ACL injuries are more frequent in sports that require a lot of twisting and turning, including:
soccer
tennis
football
skiing
basketball

Types of acl injury

ACLinjuries are categorised by severity by doctors as follows

Grade 1 sprains: The ACL can still stabilise the knee at this level, but the ligament is stretched.
Grade 2 sprains: Also known as partial tears, these include the ACL becoming loose due to stretching.
Grade 3 sprains: Also referred to as a full ligament tear, these entail the ACL rupturing into two and losing its ability to stabilise the kneecap

Diagnosis Of Acl Injury

Before making a diagnosis, a doctor will analyse the severity of the injury, the range of motion in the injured knee, and how it compares to the other knee.

They might utilise an MRI to definitely detect a soft tissue injury, such as damage to the ACL, or an X-ray to check for indications of bone damage.

Treatment of acl injury

Following an ACL injury, a physician might advise:

Depending on the severity of the injury, the patient’s age and level of fitness, several therapy modalities are used.
A doctor could advise surgery for young, healthy patients to guarantee that they can fully resume their normal activities.
Miniature cameras and tiny incisions are used during surgery to repair an ACL tear. Arthroscopy is the name of this minimally invasive surgery.

Typically, a surgeon will cut out the injured ACL and transplant a new ligament in its place. The graft may be synthetic, taken from a donor, or from the body of the afflicted person.
Researchers are investigating novel techniques, such bio-enhanced repair, to enhance ACL surgery and lower any subsequent risk of developing arthritis.

If the doctor advises against surgery and the knee is still stable, therapeutic options include:

Arthroscopic ACL Reconstruction Surgery

Surgery to replace your torn ACL (Anterior cruciate ligament) is called arthroscopic ACL reconstruction. The ACL (Anterior cruciate ligament), a ligament in the knee, connects the tibia (shin bone) and femur (thigh bone). Ligaments, which are tough connective tissues, hold bones together. If this ACL is damaged or ruptured or tears then it is called a knee injury.

A minimally invasive surgical procedure called an arthroscopy involves inserting a special camera and surgical equipment through tiny holes into the knee. The term “keyhole surgery” is frequently used to describe arthroscopic ACL surgery. The main benefit is that the surgeon doesn’t need to fully open the joint in order to examine the joint and fix any damage. As a result of the knee suffering less damage, recuperation
is sped up.

What occurs throughout an ACL reconstruction Surgery?

A person will have an intravenous (IV) line implanted in their arm prior to the surgery.The surgical team can administer anaesthetic, sedatives, or other drugs through the IV throughout the treatment.

Once the graft tissue has been chosen, the surgeon will either extract it surgically from the patient’s body or utilise a sample taken from a cadaver. The tendon is then fitted with anchor points so that it can be surgically grafted into the knee.

A small incision will be made in the front of the knee when the surgeon is ready to implant an arthroscope. This slim tube houses a fibre-optic camera and medical equipment.

The surgeon will first clean the region and remove the damaged ACL. They will next make tiny holes in the tibia and femur so they can insert posts, screws, washers, or staples to secure the bone anchors.

The surgeon will check the knee’s range of motion and tension after attaching the graft to make sure it is securely fastened.
The surgeon will then patch the incision, support it with a brace, and close the opening with stitches. Usually, the patient returns home the same day as the procedure.

Non-operative therapy is preferred for patients who:

Surgical intervention is preferred when the patient:

Since most patients fall into one of these two categories, each patient’s response to treatment should always be considered individually.

Surgical acl reconstruction effectiveness

The recovery from and success of ACL restoration are often good when paired with physical therapy. Within a year of having the operation, the majority of people can resume their sport activities.
People who receive physical therapy and exercises after surgery typically have the best success rates. The National Health Service (NHS) estimates that 80% of patients who have ACL restoration surgery recover full knee function.

Risks of acl reconstruction surgery

ACL repair surgery carries some dangers for the patient, as with any procedure.
ACL reconstruction frequently involves the following types of injuries:

clots of blood
numbness
stiffness
bleeding
unsteadiness in the knee
viral dissemination
infections near the incision site
growth-plate damage
Failure of the extensor mechanism, degeneration of other tendons, or patellar fractures

The possibility of developing osteoarthritis, ongoing pain, and a reduced range of motion are potential long-term complications.

Conclusion

During anterior cruciate ligament reconstruction surgery, the ACL is replaced and the knee’s functionality is returned using a tendon graft. In general, doctors advise it for patients with serious or complicated injuries, athletes, persons with physically demanding jobs, and younger patients.
In general, the procedure is successful, especially when it is accompanied with rehabilitation treatments like physical therapy.
A person should speak with a doctor about all possible hazards and recovery requirements.

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