This article provides comprehensive information about ACL injury treatment options....This article does not address **knee anatomy**, causes, symptoms, and diagnosis of ACL injuries....Next, ACL injury treatment options, ACL surgical techniques, rehabilitation, potential complications, and treatment outcomes are reviewed....This information helps the patient make an informed decision about ACL injury management....Injured knee ligaments....Approximately half of injuries ACLs occur with damage to the meniscus, articular cartilage, or other ligaments. Ligament injuries are considered sprains and are classified into three grades based on severity:
- **Grade 1 Sprain**: The ligament is mildly damaged and slightly stretched, but still able to maintain stability of the knee joint.... - **Grade 2 Sprain**: The ligament is stretched to the point of loosening... separated from the bone and the knee joint is unstable... as a complete or near complete tear... Prognosis (outlook) for a partial ACL tear is often good and the recovery and rehabilitation period usually takes at least 3 months.... with this Now, some patients with a partial ACL tear still experience symptoms of instability.. A complete ACL tear without surgery has a much lower outcome.. Walking... Few people are rarely able to participate in sports without symptoms of instability.... This difference depends on the severity of the original knee injury and the physical needs of the patient.. About half of ACL injuries occur with damage to the meniscus, articular cartilage (the cartilage that covers the ends of bones), or other ligaments. ... Similarly, articular cartilage lesions are more common in patients with 10-year ACL deficiency....Nonsurgical treatment of anterior cruciate ligament (ACL) injuries..Physical therapy and advanced rehabilitation can return the knee to a position close to its preinjury condition and teach the patient how to avoid excessive knee wear..However, the decision not to perform surgery makes sense for some patients...Nonsurgical management of isolated ACL tears is possible. is successful or recommended for:
- Patients who have a partial tear and do not experience symptoms of instability.... - Patients who have a complete tear but do not experience symptoms of knee instability in low-demand sports and wish to avoid high-demand sports.... - Patients who do light manual labor or have a sedentary lifestyle... and the benefits of surgery, because growth plates can be avoided with them Special surgical techniques... Surgical treatment of anterior cruciate ligament (ACL) injuries
ACL tears are not usually repaired with sutures (needle) because repaired ACLs usually fail over time....Recent studies have focused on repairing certain types of ACL tears (usually tearing or detaching the ligament from its attachment to the femur) with various techniques and the possible use of biomaterials to improve healing..However, long-term studies do not yet support widespread use..Therefore, a torn ACL is usually replaced with a graft made of Tendons are replaced, including:
- ** patellar, hamstring, or quadriceps tendon autograft ** (autograft is taken from the patient)... Active adult patients who engage in sports or occupations that require high rotational, turning, or cutting motions, or those who perform heavy manual work, are encouraged to consider surgical treatment.. This includes older patients who have previously been excluded from ACL surgery.. Activity level, not age, should determine whether surgery should be performed. be considered or No...this leads to problems because the process of ACL reconstruction leads to an increased rate of bone growth....however, recent studies can lead to an increased rate of bone growth..meniscus or subsequent cartilage injuries....a patient with an ACL tear and significant functional instability is at high risk for injury to other areas of the knee and therefore should consider ACL reconstruction..a combination of the above is common....the "unfortunate triad" often seen in soccer players and skiers It includes injuries to the ACL, medial collateral ligament (MCL) and, in general, medial meniscal injuries.. Better results.... If repair is done at the same time as ACL reconstruction, up to half of meniscal tears can be repaired and heal better.... Surgical options
### patellar tendon autograft
The patellar tendon autograft consists of the middle third of the patient's patellar tendon, along with a bone plug from the tibia and patella.
Some surgeons consider it the "gold standard" for ACL reconstruction and it is often recommended for demanding athletes and patients whose jobs do not require extensive kneeling.. have performed, graft failure rates were lower in the patellar tendon group.... In addition, most studies show the same or better results in terms of postoperative knee laxity tests compared to other grafts... Potential disadvantages of patellar tendon autografts include:
- Post-operative pain in the back of the kneecap
- Pain when kneeling
- The risk of stiffness increases slightly after the operation
- Small risk of fracture of kneecap (patella)
### hamstring tendon autograft
In a hamstring tendon autograft, the semi-tendinosus hamstring tendon is used on the medial side of the knee....some surgeons use an additional gracilis tendon attached in the same area below the knee....this creates a two- or four-strand tendon graft....proponents of hamstring grafts claim fewer complications compared to knee grafts...- less pain in the front of the knee (patella) after surgery
- Less stiffness after surgery
- Smaller cut
- Faster recovery
However, the disadvantages of using a hamstring graft may include:
- Postoperative function may be more limited compared to patellar tendon graft.... - Grafts may be slightly more exposed to tension, which can lead to increased knee laxity.... - Patient may have less hamstring strength after surgery... ### Quadriceps tendon autograft
Quadriceps autografts are often used for primary reconstruction as well as reconstruction (reconstruction). The surgeon uses the middle third of the patient's quadriceps tendon and a bone plug from the upper end of the patella, which produces a larger graft for taller and heavier patients... Possible disadvantages include:
- Since the bone plug is only on one side, the fixation is not as strong as a patellar tendon graft, so loosening may occur.... - There is a high association with postoperative pain in the front of the knee and a small risk of patellar fracture.... - Patients may not find the appearance of the incision aesthetically pleasing.... ### Allograft
Grafts from human donors are safe and effective options for some patients... Allografts are also used for patients who have previously had failed ACL reconstruction and are used during surgery to repair or reconstruct more than one knee ligament. Advantages of using allograft tissue include:
- Relieving the pain caused by taking a transplant from the patient
- Reduction of surgery time
- Smaller cuts
With modern sterilization techniques, the risk of transmitting any disease from donor to recipient is extremely low....however, some studies may point to a higher failure rate using allografts for ACL reconstruction....higher failure rates for allografts have been reported in young, active patients returning to demanding athletic activities after ACL reconstruction, compared to autografts....procedures used, age of graft donor, graft storage)...also may be due to It may be that the athletes thought the allograft allowed for a faster recovery and returned to sports too soon—before the graft was ready to withstand the loads and stresses of exercise....More research is needed to determine whether the allograft is a good option for this patient population....Surgical treatment of anterior cruciate ligament injury
Prior to any surgical treatment, the patient is often referred to physical therapy.. Patients who do not have a stiff, swollen knee with full range of motion at the time of ACL surgery may have significant difficulty regaining motion after surgery.. It may take several weeks from the time of injury for swelling and stiffness to subside, sometimes enough for immobilization surgery to be recommended.. The ACL and allowed to heal before ACL surgery.. For example, medial collateral ligament injuries (MCL) that occur with ACL injuries often heal without surgery, so only the ACL may need to be treated during surgery... The patient, surgeon, and anesthesiologist will choose the type of anesthesia used for surgery.. This final exam is used to confirm an ACL tear and to check for laxity in other knee ligaments.. The tear prepares the graft surgeon...
They either remove the graft (for autografts) or melt it.. They do (for allografts) After preparing the graft, the surgeon makes small (1 cm) incisions called portals in the front of the knee and inserts the arthroscope and instruments. ACL, the surgeon drills bony tunnels in the lower leg (tibia) and femur (femur) to place the ACL graft as anatomically correct as possible. Once the graft is in the knee, it is held in tension and fixed with screws, buttons, or other devices. The devices are then usually not removed on the skin after surgery. Place it on the patient's knee. The patient usually goes home on the same day of surgery. Pain management
After surgery, you will feel some pain...this is a normal part of the recovery process...your doctor and nurses will try to reduce your pain....medications are often prescribed for short-term pain relief after surgery....a variety of medications are available to help control pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and your doctor may use local anesthetics to minimize these medications....materials needed Opioids....Opioids can provide excellent pain relief..However, there are risks and side effects to their use....These drugs can be addictive and potentially dangerous....Therefore, it is important to use opioids only as directed by your doctor, take them as little as possible for a short period of time, and stop taking them as soon as your pain improves....If your pain does not begin to improve within a few days after surgery, let your doctor know.... rehabilitation
Physical therapy is an important part of ACL surgery success, and exercises begin immediately after surgery.... The success of ACL reconstruction surgery is highly dependent on the patient's commitment to rigorous physical therapy.... With new surgical techniques and stronger fixation of the graft, current physical therapy uses a rapid rehabilitation period.. fully straighten the knee and restore control of the quadriceps muscle... the knee is regularly iced to reduce swelling and pain.. all or part of the patient's weight from the operated leg) is also determined by physician preference and other injuries treated at the time of surgery... ### Rehabilitation
Rehabilitation goals for ACL reconstruction include:
- Reduction of knee swelling
- Maintaining mobility of the kneecap to prevent pain or stiffness problems in the front knee
- Restore the full range of motion of the knee
- Strengthening quadriceps and hamstring muscles
The patient may when:
- No more pain or swelling
- The full range of motion of the knee is obtained
- Muscular strength, endurance and practical use of the leg is completely restored
- Sense of balance and leg control is fully restored (through exercises designed to improve neuromuscular control)...Most patients are allowed to return to full sports within 6 to 12 months depending on the patient's progress, strength, and mechanics....Using a functional knee brace is not mandatory when returning to sports after successful ACL reconstruction, but some patients may feel safer wearing it.... Possible complications of surgery.. ### Infection
The risk of infection after arthroscopic ACL reconstruction is very low.... There have also been reports of deaths related to bacterial infection of allograft tissue due to improper preparation and sterilization techniques.... ### Viral transmission
Despite careful screening and processing, allografts are particularly associated with the risk of viral transmission, including HIV and hepatitis C. The probability of obtaining a bone allograft from an HIV-infected donor is estimated to be less than 1 in 1 million.... ### Bleeding, anesthesia
Rare risks include bleeding from acute injury to the popliteal artery and weakness or paralysis of the leg or lower leg. Numbness in the outer upper leg next to the incision is not uncommon and may be temporary or permanent. Although rare, blood clots in the veins of the leg or thigh are a blood complication that may cause blood to break.. Chronic instability may occur due to rupture or stretching of the reconstructed ligament or poor surgical technique.
This occurs in 5-10% of patients in the long term... ### Stiffness
Stiffness or loss of knee motion has been reported by some patients after surgery and sometimes requires surgical treatment... The surgeon either removes scar tissue or manipulates the knee under anesthesia... ### Extensor mechanism failure
A patellar tendon tear (patellar tendon autograft) or patellar fracture (patellar tendon autograft or quadriceps femoris) may occur due to weakening at the graft site. In young children or adolescents with an ACL tear, early ACL reconstruction may carry the risk of damaging the growth plate, leading to bone growth problems. However, this carries the risk of subsequent damage to the meniscus or cartilage...Alternatively, the surgeon may be able to modify the ACL reconstruction technique to reduce the risk of damage to the growth plate during surgery... ### Patellar Knee Pain
Postoperative pain in the front of the knee is common after ACL reconstruction with patellar tendon autograft... The amount of posterior patellar pain varies widely among studies... Knee pain is often greater after ACL reconstruction with patellar tendon autograft...
