The Scientific Details For Medical Professionals
Anterolateral ligament reconstruction:
Despite some anatomic inconsistencies, a majority of authors agree that the ALL femoral insertion is posterior and proximal to the lateral epicondyle, and its tibial insertion is approximately at the midpoint of the line connecting Gerdys tubercle and the fibula head 4,5,15. While its contributions to tibial anterior translation control and a high grade Pivot-Shift test are still unclear, there is a consensus that the ALL is involved in control of tibial internal rotation 1,14,18. Even with anatomic, histologic and biomechanical evidence for the existence of the ALL, several controversies exist. Whether this structure is a ligament or a capsular thickening, the importance of the ALC in ALRI is undoubted. Therefore, orthopaedic surgeons face two important challenges. The first challenge is to identify a combined ACL and ALC injury in order to define clear indication criteria for a combined procedure. The second is to determine the benefits of adding an ALL reconstruction to an ACL reconstruction, and to compare the ALL reconstruction with LET to help surgeons choose the most appropriate technique for each patient.
Lateral Extra-articular Tenodesis :
How Does The Acl Get Injured
The most common mechanism of injury is from a non-contact injury that typically occurs whilst attempting a pivoting or cutting manoeuvre during sport . The injury can also occur from contact activity when your knee buckles inwards whilst the leg is held in a fixed position. Not uncommonly, a cracking or popping sensation is felt at the time of the injury. The injury is associated with a lot of swelling within the knee that typically occurs at the time of, or soon after the injury. The leg is often painful to walk on for several days.
Figure 1. Picture of torn ACL
Will An Acl Reconstruction Make My Knee Normal
There are several advantages to ACL reconstruction. An ACL reconstruction will provide more normal knee movement and some protection for your menisci . Most importantly it should make the knee feel more normal. Most people will need an ACL reconstruction if they are planning on getting back to sports. Once you have injured your knee the risks of arthritis are there to stay. Anterior cruciate ligament reconstruction does not return the knee to normal but it offers several important advantages over non-operative care.
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When To Perform An Let Or All Reconstruction
To answer this question, it is important to differentiate between a primary ACL reconstruction surgery and a revision ACL reconstruction surgery. Primary surgery is intended to stabilise the knee after an ACL injury. A revision surgery is a procedure performed on the same knee when the first surgery has failed .
In a primary surgery incorporating ALL or LET, the objectives are to: 1) have better control of the ALRI and 2) decrease the risk of re-injury. Although the criteria are not clearly defined, this additional procedure can be recommended in primary surgery for patients with a high risk of re-rupture, such as those with high grade rotational instability, pivoting sports in high level competitive athletes, hyper-laxity, Segond fracture, or patients undergoing delayed reconstruction 7,17.
In revision surgery, the addition of an extra-articular procedure is commonly considered in the setting of a revision ACL reconstruction 20. By tightening and further stabilising the outer aspect of the knee, this additional surgery is frequently used with the intention of reducing the risk of re-injury.
Alternatives To Acl Surgery
Not everyone who ruptures their ligament needs arthroscopic ACL surgery. Exercise rehabilitation for a partially or completely torn ACL looks to build up the strength of the knee muscles so that they provide enough support and stability for the knee to compensate for the torn ACL.
It also helps train the muscles and other ligaments to provide proprioceptive feedback to gain more stability. It usually takes a few months of rehab to fully recover from a torn ACL.
Wearing a knee brace can help to provide support and protection to stop the knee from giving way. There are a whole range of braces out there that can help depending on the level of instability – visit the ACL knee brace section to find out more
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Is Acl Reconstruction A Major Surgery
Injuries requiring reconstruction or replacement of the ACL are common among athletes. ACL reconstruction surgery can help restore range of motion, function and stability to the knee joint after an ACL injury. ACL reconstruction surgery is a common but major surgery with risks, like any other surgery. But, for most, the rewards outweigh those risks.
What Questions Should I Ask My Healthcare Provider
- What are the pros and cons for surgery to repair my ACL tear?
- Do I have a partial ACL tear or is it torn in two?
- What medications should I take?
- Do I need to see a specialist?
- Who is a good orthopedic surgeon?
- Should I see a specialist in sports medicine?
- When can I return to work/school?
- How soon can I have surgery?
- How long do you predict it will take me to recover?
- What kind of graft is best for me?
A note from Cleveland Clinic
An ACL tear will only temporarily stop you from working your job or playing the sports you love. Remember, your healing depends on your own choices: choices to use crutches, to have surgery or not, to work hard at your physical therapy, etc. If you commit to your physical therapy and listen to your healthcare providers instructions, then your life will be back to normal soon.
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How Acl Reconstruction Is Performed
Youll be prepped for the surgery by changing into a hospital gown and having an intravenous line placed in your arm. The IV will allow the surgical team to administer medications, anesthesia, or sedatives.
Once the sample tissue is selected, its either surgically removed from your body or prepared from a cadaver. The tendon is then outfitted with bone plugs, or anchor points, to graft the tendon into the knee.
During surgery, a small incision is made in the front of the knee for an arthroscope a thin tube outfitted with a fiber optic camera and surgical tools. This allows your surgeon to see inside your knee during the procedure.
The surgeon will first remove your torn ACL and clean the area. They will then drill small holes into your tibia and femur so the bone plugs can be attached with posts, screws, staples, or washers.
Following the attachment of the new ligament, the surgeon will test your knees range of motion and tension to ensure the graft is secure. Finally, the opening will be stitched, the wound dressed, and your knee will be stabilized with a brace. The length of the surgery will vary depending on the experience of the surgeon and if additional procedures are performed , among other factors.
Typically, you can go home the day of your surgery.
Because ACL reconstruction is a surgical procedure, it carries certain risks, including:
How Soon Should You Get Acl Surgery
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.
Orthopedic surgeons gauge the appropriate timing of reconstruction surgery based on:
- whether there are other injuries present that need to be treated first
- the physical appearance of the knee
- the patients level of pain
- the patient’s range of motion and quality of muscle control when flexing or extending the leg
Some evidence suggests that delaying ACL reconstruction surgery for six months or longer after injury reduces a person’s chances of having a clinically significant outcome and leads to increased rates of the need for future revision surgeries.
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What Are The Causes Of A Meniscus Tear
- Any activity causing you to forcefully twist or rotate your knee, especially when putting your full weight on it, or by lifting something heavy can lead to a meniscus tear.
- The meniscus weakens with age and meniscus tears have become more common in people over the age of 30. If you have osteoarthritis, you are at a higher risk of injuring your knee or tearing your meniscus. Osteoarthritis is a common joint disorder involving pain and stiffness in your joints which is caused by aging and wear and tear.
- When an older person experiences a meniscus tear, it is related to degeneration. This is when the cartilage in the knee becomes weaker and thinner and as a result, it is more prone to tear.
Acl Reconstructive Surgery In Kirkland Wa
The anterior cruciate ligament is one of the four major ligaments of the knee. Twisting or pivoting movements are what cause the ACL to strain or tear.
Ligaments are strong, dense structures made of connective tissues that help stabilize a joint. The ACL connects the femur to the tibia and helps provide stability to the knee and minimize stress across the knee joint.
Dr. Fuchs is a board-certified orthopedic surgeon that specializes in diagnosing and treating patients suffering from an ACL strain or tear. Call to schedule an appointment at our office in Kirkland, WA today!
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What Is The Recovery Time For Acl 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:
- Strengthening and range-of-motion exercises are started early in the recovery period.
- Running exercises begin at about four months.
- Pivoting exercises are started at around five months.
- Return to playing competitive sports can begin as early as six months.
The degree of pain associated with ACL recovery varies and can be addressed successfully with medication. Recovery time also varies from patient to patient. The determination of when a patient has fully recovered is based on the restoration of muscle strength, range of motion and proprioception of the knee joint.
Arthroscopic surgical techniques have made recovery times quicker and easier in comparison to open surgery, which is how ACL reconstruction performed in the past. But to achieve a successful outcome, it is critical that the patient have a rehabilitation period that is carefully supervised by an appropriate physical therapist, as well as to have follow-up appointments with the surgeon.
Acl Reconstruction Surgery Steps
Reconstruction of the ACL follows a number of basic steps, although they may vary slightly from case to case:
- The orthopedic surgeon makes small incisions around the knee joint, creating portals of entry for the arthroscope and surgical instruments.
- The arthroscope is inserted into the knee and delivers saline solution to expand the space around the joint. This makes room for surgical tools, including the arthroscopic camera, which sends video to a monitor so that the surgeon can see inside the knee joint.
- The surgeon then evaluates structures that surround the torn ACL, including the left and right meniscus and the articular cartilage. If either of these soft tissues have any lesions, the surgeon repairs them.
- Next the graft will be harvested . A section of tendon from another part of the patient’s body is cut to create a graft, which is then attached at each end to plugs of bone taken from the patella and tibia. These plugs help to anchor the graft that will become the new ACL.
- The surgeon inserts the new ACL into the femur and tibia using a flexible guide wire.
- Screws are used to secure the plugs of bone. Over time, these plugs will grow into the surrounding bone.
- The surgical instruments are removed to complete the procedure.
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Will Physiotherapy Help Before And After Surgery
Yes! It is crucial to achieving the best recovery that you can.
Increasingly we are seeing that better outcomes are enjoyed by those who work at the knee after surgery. Physiotherapists, the myrecovery app, and your personal support network are all important resources that we can draw on.
The value of physiotherapy cannot be overemphasised. The goals of the physiotherapy programme are to:
- Enable you to enter surgery with the greatest fitness possible
- Avoid postoperative stiffness
- Help you avoid high-risk activities whilst the new ACL beds in
Why Is Acl Reconstruction Done
The goal before surgery is to reduce pain and swelling, to restore your knees full range of motion, and strengthen muscles. Not all ACL tear require surgery. Your physician will decide whether only rehabilitation or surgery plus rehabilitation is right for you.
You may choose to have surgery if you:
- Have a completely torn ACL and your knee is very unstable.
- Have gone through rehabilitation and your knee is still unstable.
- Are very active in sports or have a job requiring knee strength and stability , and you want your knee to be just as strong and stable as it was before your injury.
- Have chronic ACL deficiency, that is when your knee is unstable and affecting the quality of your life.
How is ACL reconstruction performed?
Before your surgery, you will have to undergo several weeks of physical therapy. ACL reconstruction is performed with general anaesthesia and it is an outpatient procedure, so you will be able to go home on the same day.
Step 1 ACL reconstruction is usually done through small incisions. One to hold a thin, tube-like video camera and others are to allow surgical instruments access to the joint space.
Step 2 Your surgeon will remove your damaged ligament, and replace it with a segment of tendon, which is called a graft. This can be an autograft or an allograft .
What happens after ACL reconstruction?
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What Is The Role Of A Meniscus In A Knee Joint
The meniscus is a crescent-shaped disc of cartilage which is between your femur and tibia . There are two menisci in each knee joint. The meniscus is like a shock absorber that helps to stabilize the knee by balancing your weight across the knee. It also provides protection of healthy cartilage in the knee joint.
What Is Recovery Like
Physical therapy is an important part of your recovery. You’ll start PT about a week after surgery and continue for the next few months. The physical therapist will help you put more and more weight on your leg until you don’t need the crutches anymore.
You also might use a CPM machine that slowly bends your knee back and forth. This helps you get back in the habit of moving your knee.
When your thigh muscles regain their strength , you’ll be able to stop wearing the knee brace.
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Diagnosis Related To Acl Surgery
The anterior cruciate ligament is an important ligament in the knee. This ligament provides stability to the knee. Despite its strength, this ligament can tear easily.
ACL tears are one of the most common injuries among athletes, with 100,000 to 200,000 ACL ruptures each year in the United States alone.
Most of these injuries occur outside of professional sports, but they do happen a lot in athletes. Football is one of the sports with the highest risk of ACL injury, and female athletes are more prone to ACL ruptures than men.
With an ACL injury, you may experience pain, swelling, and even difficulty walking. When your healthcare provider first examines the injury, it can be difficult to make a full diagnosis due to swelling at the injury site.
Before a diagnosis is confirmed, your healthcare provider may ask you to do the following things, which are represented by the acronym RICE:
- Rest: Avoid weight bearing on the injured knee.
- Ice: An ice pack can help reduce pain and swelling.
- Compression: Use an elastic bandage or compression wrap on the knee.
- Raise: Lie down and lift the injured knee.
It may take several weeks of rehabilitation, either with a physical therapist or at home, before you get more comprehensive medical care for your ACL injury, such as surgery.
Knee braces or crutches may help stabilize your knee while you finish treatment. The goals during this time are to reduce pain and swelling, strengthen the muscles, and maintain a full range of motion in the knee.
Let All Reconstruction: What Does It Mean
Both these two procedures may be performed in combination with ACL reconstruction.
The first type of anterolateral extra-articular procedure developed was the Lateral Extra-articular Tenodesis . This procedure concentrated on stabilising knee rotational instability using the ilio-tibial band to reinforce the ALC. Whatever the technique used, an LET usually involves fixing a part of the ITB to the femur just above the knee joint. Methods of performing an ITB lateral tenodesis were described initially by Lemaire in 1967 , MacIntosh in 1972, and Ellison in 1979 as a novel way of controlling ALRI. Despite some improvements of the original techniques, these eponymous terms are still used today 7,16.
With the renewed interest for the ALC, some surgeons developed new procedures to reconstruct the ALC and especially the ALL: the ALL reconstruction 2,11,19 . The aims of this procedures are similar to the LET, but it attempts to reconstruct a native ligament to be more physiological and anatomical, similar to the native ALL. In short, an ALL reconstruction involves fixing a free graft between the tibia and the femur in the same location as the native ALL.
Figure 2. Lemaire surgical technique.
Reprinted with permission from Dr Rob LaPrade .
Figure 3. ALL reconstruction techniques with one 2 or two bundle 19.
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