ACL injuries are one of the most common sports injuries: spraining or tearing an anterior cruciate ligament (ACL) is caused by a sudden force twisting the knee while the foot is firmly planted on the ground and the leg is straight or slightly bent. Such a sudden impact can happen when the person changes direction or decelerates quickly, such as when playing football, or when landing from a jump, such as when playing basketball.
An ACL sprain or tear can occur not only during sports, but also when weight is suddenly shifted from one leg to the other, when the knee is hyperextended beyond its normal range of motion or when a direct blow to the knee occurs.
Symptoms of ACL injury
In severe cases with a completely torn ACL, the knee quickly becomes inflamed and swollen. Due to the severe pain, the person can hardly put any weight on it.
Milder sprain cases might feel an irritation under the shin, with swelling of the knee within a few hours of injuring it.
Pain may prevent the patient from walking normally or engaging in other activities.
Initial emergency measures
As immediate action, rest the leg and avoid putting weight on it. Icing the knee for 20 minutes at a time several times a day helps reduce swelling, as does an elastic bandage or compression wrap. Try to elevate the leg above the level of the heart to reduce blood flow through the inflammed knee.
Self-healing or not
Not all ACL injuries require surgery, rehabilitation might be the correct treatment. Natural recovery varies from patient to patient, by and large depending on the patient’s degree of ACL injury, activity level and instability symptoms. The prognosis for a partially torn ACL often is dependent upon other injuries as well as the patien’ts age and activity level, with recovery and rehabilitation usually lasting for at least six months to years.
Surgery may not be avoided if the patient’s ACL is torn completely or if the tear is partial and the knee is unstable with any concomitant injuries. Surgery offers the benefit of regaining full knee control and capacity. Biomechanical studies have shown that a reconstructed ACL can be about 70 percent stronger than a normal ACL at the time of implantation.
Surgery usually is performed once the acute inflammatory phase has passed. This is to significantly reduce the risk of a stiff knee after the operation. Bumrungrad specialist surgeons usually perform either single-bundle or double-bundle ACL reconstruction using knee arthroscopy. Double bundle ACL reconstruction is a new technique that has evolved significantly in recent years as a superior treatment option for torn ACL.
ACL reconstruction surgeries at Bumrungrad are minimally invasive, with minimal tissue trauma and performed by highly experienced surgeons. Surgeons first use a camera to visualize the inside of the joint. They then make tiny incisions around 0.5 centimeters long. Usually two to three incisions are required to perform the surgery.
The procedure takes approximately one to two hours to complete, general anesthesia is typically used during ACL reconstruction. Some patients are given an epidural nerve block during their surgery. After the procedure, the patient can expect to spend one or two hours in the recovery room and go home on the same day of surgery or after 1-2 nights stay.
Recovery of comfort and function after arthroscopic ACL reconstruction takes several months. However, thanks to significant advances in the field of ACL reconstruction over the past decade, patients recover from surgery much more quickly than in the past, with the chances of a full recovery being high. Full restoration of knee functionality depends on several factors and each operation is performed with the goal of up to 100 percent recovery and to prevent re-injury.
Surgery is the first step to restore knee functionality. No less important is physiotherapy to bring the patient back to pre-injury knee performance and ability as soon as possible.
Importance of physiotherapy
The best surgery cannot achieve the desired effect if physiotherapy is not followed seriously. Three factors are important: regaining terminal knee extension, being able to bear weight and strengthening the knee to open and close.
Physical therapy re-teaches the patient how to move and strengthens areas of weakness. The aim is to correct any muscular imbalances – which may have contributed to the ACL injury – and to re-learn correct form and movement.
Rehabilitation takes time and dedication. Bumrungrad multidisciplinary teams at the Sports Medicine and Joint Center will put together a detailed, custom-tailored physiotherapy plan and accompany the patient throughout this important recovery process. The aim is to regain full knee strength and reduce the risk of re-injury, so that that the patient can get back in the game for good.
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