Because people who have had an ACL injury are more likely to develop osteoarthritis in the knee earlier in life than those who do not, HSS physicians and scientists also continually investigate ACL surgery techniques to improve the short-term and long-term outcomes for patients.
The need for surgery depends on the severity of the ACL tear and the lifestyle of the patient. A completely torn ACL cannot heal on its own. Studies have shown, however, that in some patients who experience a partial tear of the ACL, the ligament may heal without the need for surgery. In patients who have only a partial tear, it may be recommended to delay surgery and first see if the ligament heals without it.
People who have completely torn their ACL and who maintain an active lifestyle — especially competitive athletes — will need surgery return to their prior level of activity and avoid future injury. In some older patients or others whose lifestyles do not include rigorous exercise, nonsurgical treatments may allow them to return to normal routines without an intact ACL. However, anyone who returns to unrestricted activity with a completely torn ACL will likely experience some knee instability.
In they are much more likely to tear their meniscus. The meniscus is a pad of cartilage that cushions the bones that meet at the knee joint. There are two menisci on each knee: the medial meniscus on the inside of the knee and the lateral meniscus on the outside. A torn meniscus will cause knee pain and, sometimes, swelling.
More importantly, however, a damaged meniscus increases a patient's risk of developing osteoarthritis of the knee later in life. For a complete tear of the ACL, reconstruction surgery is generally scheduled for between three and six weeks after the injury occurs.
This allows inflammation in the area to subside. If surgery is performed too early, patients may develop a profound scarring response called arthrofibrosis. ACL reconstruction surgery is performed using minimally invasive arthroscopic techniques, in which a combination of fiber optics, small incisions and small instruments are used.
A somewhat larger incision is needed, however, to obtain the tissue graft. ACL reconstruction is an outpatient ambulatory procedure, in which patients can go home on the same day as their surgery. It usually takes six to nine months for a patient to return to participating in sports after an ACL reconstruction, depending on the level of competition and the type of activity.
Patients are able to walk with crutches and a leg brace on the day of surgery. Very soon after surgery, the patient enters a rehabilitation program to restore strength, stability and range of motion to the knee. The rehabilitation process is composed of a progression of exercises:.
The degree of pain associated with ACL recovery varies and can be addressed successfully with medication. The gracilis, a tendon attached below the knee, is sometimes used by surgeons, creating a tendon that is made up of two or four strands.
This ACL surgery is often used because of the ease in which surgeons can harvest the hamstring tendon. There is also fewer problems knee or kneecap pain after surgery, less stiffness, a smaller incision is used and leads to a faster recovery. Some studies suggest that this surgery leads to stretching of the tendon and a lessening of strength in the patient.
Hypermobile patients those with knee hyperextension over 10 degrees or an intrinsic ligamentous laxity are recommended to proceed with the PTA surgery. For patients who have failed previous ACL reconstruction, the quadricep tendon autograft is used. A bone plug from the knee cap and the middle third of the quadricep tendon are used, allowing for a larger graft for heavier, taller candidates.
The fixation is not as solid as the PTA since there is only one bone plug. While their is a low risk of patella fracture, their is a high risk of post-surgery anterior knee pain. And the incision can be pretty ugly. This is becoming a popular procedure for first time ACL surgery patients, but as well as for those who have failed previous ACL reconstruction.
This is also used when there is more than one knee ligament to be repaired. There is no pain to the patient from harvesting a ligament from their body, there is less recovery time and the incisions are not as big. Of course, the most significant difference lies in philosophy. One depends on a brand new, collagen-rich replacement. The other trusts that the body can repair the damaged ligament once repaired. Repair also has the advantage of shorter recovery time compared to rebuilding.
At the same time, ACL repairs only work in specific circumstances. A good example is if the ACL tore cleanly off the bone and is still intact. The difference comes down to the needs of the patient, degree of damage, and surgeon expertise. In the realm of orthopedic surgery, repair versus reconstruction is a hotly contested topic. Many surgeons and scientists believe that repair does not work long-term as the ligament lacks blood flow.
Some research backs up this concern. For example, over time, repaired ACLs can cause damage to other critical areas like the meniscus. However, other studies see no difference in success rates. ACL reconstruction is proven while there are still mixed reviews on a repair. ACL tears can be distressing. However, the right surgical procedure can get patients walking again. In most cases, ACL reconstruction has long-term benefits. However, there may be some cases where ACL repair will be successful, with shorter recovery.
The best bet is to seek help from an orthopedic surgeon who understands both procedures. The surgeon will give sound advice based on factors like age, health, and degree of tear. Minnesota Valley Surgery T October 19th, A herniated disc can cause pain and discomfort. Look for these 4 clear signs and speak with a doctor about a possible laminectomy.
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