ACL Injury & Reconstruction
The cruciate ligaments are the central pillars of stabilization of the knee joint. Their main task is to secure the knee joint compared with braking and accelerating actions and rotational movements. Injuries of the cruciate ligaments affect over 90% of the anterior cruciate ligament (ACL).
Following a trauma, swelling over the joint comes as the first sign of injury. By eliminating the stabilizing cruciate ligament, physiological joint play (kinematics) is disturbed and an instability symptoms (“giving way” symptoms) results. This may be secondary to damage to the menisci and the articular cartilage as well.
Cruciate ligament injuries occur as a consequence of acute sports and accident injuries. After a cruciate ligament injury, the knee swells due to a hematoma. The other symptoms are a painful knee limited mobility and a dependence existing in the degree of injury feeling of instability.
High-risk sports are mainly the so-called high-risk pivoting sports such as football, hockey, volleyball, tennis and cricket.
The diagnosis may be difficult in the acute condition as pa
in, swelling and muscle tension impedes the investigation. However, after a due rest and decrease in swelling, clinical examination reveals positive anterior drawer, Lachman and pivot shift tests. Besides the orthopedic examination, a magnetic resonance imaging (MRI) in fresh cruciate ligament injury is advised, since a high percentage of concomitant injuries, such as meniscus, ligament- present and cartilage damage. With MRI, the full extent of the injury can be determined very accurately.
Particularly relevant experiences MRI thus also with respect to the surgical planning and the assignment surgery requiring combined lesions of the menisci, the collateral ligaments and / or the postero-lateral ligaments with demolition of the popliteus tendon.
After a cruciate ligament rupture, the most important outcome expected from the surgery is the re-attainment of sports ability. The need for surgery depends on activity, symptomatic instability and age. Especially the sports-oriented patient benefits from a timely surgical treatment.
As a rule, surgery is performed 6-8 weeks after the traum
a, after the initial signs of inflammation are over. For cruciate ligament reconstruction preferably hamstring or patellar tendon grafts are used as a standard procedure. Restoration of knee function and stability is expected after about 6-8 months.
A conservative treatment attempt, however justified at low instability symptoms and low physical stress claim. For Cruciate ligament injuries in childhood and adolescence, early surgical reconstruction using appropriate techniques should be considered in order to prevent more serious damage within the meaning of secondary articular cartilage and meniscus damage. Cruciate ligament surgery procedure in the anterior cruciate ligament (ACL)
Due to the enormous development of arthroscopic surgical techniques, treatment options for the cruciate ligament replacement in recent years have been greatly improved. Shorter operative time, less surgical trauma, less pain and better cosmetic results today speak for this minimally invasive surgical technique. A correct surgical procedure requires a high level of experience.
Rehabilitation after cruciate ligament reconstruction represents a significant component of the treatment. The primary objective is on the one hand focused on the early return-attainment of a free range of motion, full load and muscular control and coordination. On the other hand, current treatment concepts are adapted to the scientifically proven biological healing phases. Currently, the propagated in the 90s accelerated rehabilitation program an adapted and more restrictive post-operative treatment planning has given way and takes into account the individual tissue reaction and the healing process. The post-operative care by a, stabilizing the knee joint, knee brace is now recognized as a standard. When optimally performed rehabilitation is expected to load stable restoration of knee function and stability after 6-9 months.
MY rehabilitation program after ACL Reconstruction:
Stationary phase (2-3 days): Icepack and lymphatic drainage- Beginning with physiotherapy in pain-free range and gait training on crutches. Removal of suction drains on day 2. Primary Development of active knee stretching, isometric Quadriceps exercises, self training exercises and motor rail.
ROM: • 1 Week to 60 ° knee flexion • 2 up to 4 Week 90 ° • then release the mobility.
Loading: • 5 kg on crutches (toe touch) for a week • 2nd-3rd Week 20 kg • then transition to full load as a function of the muscular control.
Sporting ability: • Cycling, Walking about 6 weeks postoperatively • jogging about 3 months postoperatively • contact sports, football, tennis etc. 6-9 months postoperatively.