Foot And Ankle Treatment Delhi

ACL Reconstruction

Anterior cruciate ligament reconstruction (ACL reconstruction) is a surgical technique where a tissue graft replaces the damaged anterior cruciate ligament to restore its function after injury. The surgery is performed with arthroscopy. Two alternative sources of replacement material for ACL reconstruction are commonly utilized:

  • Autografts (tissue harvested from the patient's body): Since the tissue is ones own in an autograft the probability of rejection is minimal. And the graft has no risk of disease transmission.

  • Allograft (tissue harvested from a donor's body typically a cadaver’s): Sterilization and redundant donor screening processes make Allografts a generally safe choice for patients. But still it has calculative risk of disease transmission and higher chance of rejection. It incurs huge cost for the retrieval and processing which ultimately beared by the patient only. It is not readily available in India, have to import from USA.

How Arthroscopic ACL reconstruction is performed?

Knee joint is accessed and visualized through multiple key-hole incisions with the help of Arthroscope. Tunnels are prepared in both the femur and tibia with the help of special jigs and instrument to pass the tissue graft at precise anatomical position for ACL reconstruction. Tissue graft commonly harvested either from hamstring tendon or patellar tendon along with adjacent bone from patella and tibia. Tissue graft is fixed within the bony tunnel either with loop endobutton on femur side and screw on tibia side or only with screw on both sides.

How the rehabilitation and progression of recovery continues?

Post operatively the patient requires extensive physiotherapy. Initial physical therapy consists of range of motion exercises, often with the guidance of a physical therapist. Range of motion exercises are used to regain the flexibility of the ligament, prevent scar tissue formation or break it down and regain muscle tone. Range of motion exercises; examples include quadriceps contractions and straight leg rising. In some centre CPM (continuous passive motion) device is used immediately after surgery to help maintaining joint flexibility. The preferred method of preventing muscle mass and tone loss is isometric exercises that put zero strain on the knee. Knee extension within two weeks is important with many rehab guidelines.
Approximately six weeks is required for the graft to attach to the bone. However, the patient can typically walk their own and perform simple physical tasks prior to this with caution, relying on the surgical fixation of the graft until true healing (graft attachment to bone) has taken place. At this stage the first round of physical therapy can begin. One of the more important benchmarks in recovery is the twelve weeks post-surgery period. After this, the patient can typically begin a more aggressive regimen of exercises involving stress on the knee, and increasing resistance. Jogging may be incorporated as well. After four months, more intense activities such as running is possible without risk. After five months, light ball work may commence as the ligament is nearly regenerated. After six months, the reconstructed ACL is generally at full strength (ligament tissue has fully re-grown), and the patient may return to activities involving cutting and twisting if a brace is worn. Recovery varies highly from case to case, and sometimes resumption of stressful activities may take a year or longer.
The reconstructed ACL has a high success rate. Studies show that cases in which the ACL re-tears are generally caused by a traumatic impact. Some studies indicate that wearing a brace during athletic activity does not reduce probability of re-injury to the ACL, but a study of active post-ACL replacement skiers shows a 64% reduction in re-injury likelihood by using a knee brace after recovery. A sufficiently traumatic impact to re-tear the ACL is unlikely to be mitigated by the use of a brace