Anterior Cruciate Ligament (ACL) Surgery in Hyderabad

The ACL or Anterior Cruciate Ligaments is one of the two ligaments inside the knee joint. Together the ACL or PCL stabilise the knee. The ACL travels from the back to the front of the knee joint and is connected to the femur and tibia. The ACL plays a important role when you perform activities in sports that require changing in direction. When the leg and body change the direction, the ACL holds femur and tibia together. If the knee receives too much stress, the ACL could be sprained or completely torn. Without the ACL, the tibia cannot move forward freely making the knee less stable. To confirm the degree of your ACL injury, the experts at our orthopedic hospitals in Hyderabad will perform a physical exam and using imaging like X-ray and MRI. If surgery is required, doctors specialised in surgery techniques that repair the ACL will protect the growth plate around the knee.

Growth Plates determine the future link and shape of the bone. So protecting them in specifically important to children and young athletes who are still growing.

What is the Anterior Cruciate Ligament (ACL):

ACL is a strong stabilising structure in the knee. It rope essentially keeps knee stable. It is one of the most commonly injured ligaments in the knee. And it basically keeps the tibia or shin bone from sliding of the underneath from the femur of the thigh bone

How does an ACL Injury Occur?

If you suddenly stop or something then your ACL can tear. Sometimes if you land incorrectly, or you can also get direct blow or hit to your knee which can cause ACL tear.

What age group accounts for most ACL Injuries?

ACL injuries are typically happened in males some more between the ages of 19 to 25 with most frequency and in females between the ages of 14 to 18. ACL can also happens in much younger children and it has been found that, ACL injuries in youngest patients can have happening more in recent years.

What are the signs and symptoms of a possible ACL tear?

Traditionally we describe a path that happens in your knee when you are into your ACL. But you can also have large amount of swelling and the swelling could cause your knee to feel unstable when you try to walk and may feel difficulty in walking. On top of that, you may also have some difficulty in bending your knee.

What is an ACL Reconstruction?

An ACL Reconstruction is basically taking the torn ACL and replacing it with tissue graft. The type of graft depends upon the characteristics of the patient and their demands.

What are techniques to reduce ACL injury risk?

There are number of different training programs you can participate in to reducing ACL Injury Risk. This training program really focus on course strength, balance, cutting and pivoting and also exercises to reduce the risk of ACL there by improving your mechanism and participating in sports. In terms of after an ACL tear and after an ACL reconstruction, it’s important to wait until your knee is fully recovered to reduce the risk of an new ACL injury

ACL Surgery Procedure:

To begin this surgery, surgeon will make several small holes and an incisions for the instruments and the camera. Once inside, your surgeon will examine your knee for any other damage and addressing is needed.

Surgeon will remove remaining scar tissue and torn ACL. Your new ACL can be created from a number of different tissues around the knee. Doctor prefer to use tissue connect in quadriceps and knee cap. The new ACL is prepared. Then tunnels are carefully digged in the bone avoiding growth plates.

Now, the surgeon places the new ACL in the tunnels and securely inquisite within the knee. The new ACL secures the tibia and stabilises the knee. In Order to get back to your sport safely and reduce the chances of retear, it’s important to complete your post-surgery rehab.

Recovery After Surgery:

After the procedure, the patient will me moved to the recovery room for 2-3 hours and then go home same day. Patient will be likely need a knee brace and crutches for 1-4 weeks.

Physical Therapy:

Supervised Physical Therapy should begins 2 or 3 days after surgery and continues for 6 to 10 weeks. After this time, continue with self-directed therapy as long as needed. It takes about 9 months for a reconstructed ACL to fully heal.

When You First Get Home:

When you first get home, you will become your main caregiver. Here are the most important things to keep in mind when you are at home.

• Continue to use your crutches as instructed
• If you received a femoral block, you will start to get feeling back in your leg the morning after the surgery. But you will have difficulty in controlling your leg as quadricep muscles are paralysed until the block completely wears off.
• Wear your brace at all times as instructed by your surgeon
• Arrange Physical therapist 2 to 3 times a week before you leave the hospital
• Do not swim. Also bath in hot tubs, until your surgeon gives you go ahead sign
• Do not use ointments, lotions, oils or vitamin preparations on your incision until after first follow-up appointment
• Use the cooling system on your knee for 20 minutes, 6 to 8 times a day to help with pain and swelling.
• Take all the medication with the food to avoid nausea
• To help your wound heal faster, continue healthy eating habits, quit smoking, if you are a diabetic maintain good glucose level.
• Do not allows the pets to share the space while you are sleeping or resting. They can infect your incision.

To Reduce Infection:

To reduce the chance of getting infection, make sure you knows around wash the hands thoroughly when,

• They are visibly soiled
• Before and after care of your incision
• Before eating
• After going to the bathroom
• After handling the pets

How to Shower after ACL Surgery:

You can shower, when you get home from the hospital. But you must be very careful while following the instructions. Your surgeon will warn you to cover your brace with the bag anytime you shower and your leg is completely to healed. Hospital will give you shower bag at first postoperative visit. This bag will help keep your leg dry until you are allowed to get your incision wet at 10 to 14 days after your surgery.

It is recommended to sit while taking the shower. Remember do all you can do to keep your incision dry. But if it does become wet, gently pat it with the clean towel.

Exercising After ACL Surgery:

All the instruction that is given by your nurse at your first postoperative visit are goals to get you full range of motion in 4 to 6 weeks.

Day 1:

Start with only one foot and ankle motion. Do not move your knee.

Day 2:

• Start gentle quadriceps strengthening, hold for a count of 5 and relax. Repeat 5 times every few hours.
• Start walking on weight bearing with crutches and walker
• Climb the stairs slowly

Day 3:

Start passive knee bending, bend the knee to 5 degree with the support of your hand, you may also move the leg from side to side.

For the first week continue Ankle Motion, side to side motion of entire leg gentle tightening of thigh muscles, progressive knee bending. And the goal for your 1st week is to reach upto 30 degree of knee flexion.

Week 2:

• Walking weight bearings using crutches and walker
• Walking weight bearings on stairs

Isometric Hamstring Exercises:

• Bend your knee to 30 degree, hook the heel against the edge of the bed and they gently pull the heel towards the buttock. Feel the muscles at the back of the thigh tighten. Hold for a count of 5 and then relax. Repeat 10 times and do 3 sets.

Assisted Straight Leg Lifts:

• Loop a long towel or dupatta around your foot and gently raise the leg to 30 degrees, lower it to 5 degree and raise again. Repeat 5 times and do this 3 to 4 times during the day. As you get the strength and are pain free you can try to lift the leg straight up without external support.
• If you have difficulty in keeping the knee straight while walking, rest your heel on a stool or chair in front and without any support below the knee. Try to push it down as far as it goes, hold for a count of 5 and relax.

By the end of the 2nd week, your knee should straightener completely and bend easily to 60 degrees. You should be able to walk without crutches or walker.

Week 3:

Heel Slides:

• Lying on the back, bend the knee and gently slide the heel along the bed towards the buttock as far as possible and then straighten the knee again. Repeat this about 5 times every couple of hours.

Wall Slides:

• To increase knee bending, stand with your back against a wall (do this only after removal of knee brace), place your feet apart at a comfortable distance, slowly bend in your knees and hold the position for a count of 5 and come up again. Repeat 5 times every few hours.

Step Up:

• To increase muscle strength, step on a 6 inch high stool leading with your operated leg. Step down, with the un-operated leg returning to the starting position and repeat 10 times. Do thrice a day. If you do not have a stool, the same could be done using the steps in the house.

Leg Presses:

• To strengthen the muscle in the front of thigh, using a theraband or thera tube. Take light resistance tubing-check the color code. Grip the tubing with both your hands. Loop it around your foot and bend the knee and then push against the tube till the knee straightens. Repeat 10 times 3 times in a day. Gradually start using higher resistance bands.

Heel Raises:

This helps increases calf muscles strength. Stand holding on to the edge of a table. Slowly raise both your heels so that you are standing on your toes and then slowly lower again. Repeat 10 times, 3 times thrice daily.

At the end of 3rd Week, one should achieve 90 degrees bending, sufficient strength to climb steps, do straight lifts can gave sufficient strength with a near normal gait so that the long knee brace can be discarded. You may start using a hinged knee cap only to be worn while outdoors.

Week 4:

• Side leg raises
• Back leg raises
• Adductor (inner thigh raise)
• Tie a light 1 to 2 kgs weight cuff band around the ankle and do Marching like actions, back cuff in standing, straight leg lifts, leg extension without straightening the knee completely.

At the end of 4th week, one should be able to resume sedentary work, negotiate stairs confidently.

Avoid the Following:

• Contact Sports
• Racquet Sports
•  Other sports that require rapid direction changes until you obtain a approval from your physician.