blog is about general information on Anterior Cruciate Ligament (ACL) surgery 
Australia, Commonwealth of (Press Release) February 2, 2008 --
Now a days as health conscious international patients are coming to India for Anterior Cruciate Ligament(ACL) surgery, their queries regarding this procedure is also increasing. They are suggested to submit their queries at suggested sites like fly2india4health.
What is the anterior cruciate ligament(ACL)surgery?
The anterior cruciate ligament surgery (ACL) is one of a pair of ligaments in the center of the knee joint that form a cross, and this is where the name "cruciate" comes from. There is both an anterior and a posterior cruciate ligament (PCL). Both of these ligaments function to stabilize your knee from front-to-back. In medical terms, the anterior cruciate ligament surgery (ACL) is the primary restraint to anterior displacement of the tibia on the femur. Translation in plain English, that when the ACL is injured or torn the shinbone can then slide forward on the thighbone, causing the knee to become unstable and “give way”.
Anterior cruciate ligament surgery begins with an arthroscopic examination of the inside of your knee. Arthroscopic surgery has revolutionized the process of ACL reconstruction (and orthopedic sports medicine in general). This surgical technique uses three very small incisions that are about 1/4 of an inch in length to create viewing access into the knee. A fiber-optic light source lights the inside of the knee and a video camera sends an image to a monitor so that the surgeon can see inside the knee. A sterile saline solution is continuously pumped through the knee so that the surgeons vision field is always clear.
During arthroscopic knee surgery, the surgeons maneuver their tools by watching the image (provided by the arthroscope) displayed on a video monitor.
Your surgeon will inspect the knee for damage to the cartilage or the menisci, the remnants of the torn ACL are removed with a shaver. This tool is a special device that is used to remove torn ligaments or torn pieces of cartilage from the knee. The surface of the intercondylar notch where the ACL normally attaches to the femur is then prepared with a high-speed burr so that the proper location for the tunnel. Tunnels are then drilled through the bone in the femur and the tibia so that the graft can be placed in the center of the knee in the same position as the original ACL.
A separate incision that is about 2 to 3 inches long also has to be made in order to harvest the graft from either the patellar tendon or the hamstring tendons. After the graft has been harvested, it is then prepared by placing several very strong surgical sutures through the graft that are used to fix it in place.
After the graft is passed through the tunnels, it is then tightened and fixed into place. A variety of fixation techniques have been developed to anchor the graft to the bone. Different techniques are used for different types of grafts, and today, fixation failures, though possible, are very rare.
Once the graft has been fixed in place and any additional damage has been addressed, the incisions are closed and a sterile dressing is used to cover the knee.
This dressing will remain on for several days.
Four ligaments connect the thighbone (femur) to the shinbone (tibia). The ACL is in the center of the knee and keeps the femur from rotating too far, and from moving too far forward over the tibia.
Why the anterior cruciate ligament surgery Procedure is Performed
ACL reconstruction may be recommended for knee problems such as:
Unstable knee
Knee that gives way
Knee pain
Inability to play sports or other activities
Risks
The risks for any anesthesia are:
Allergic reactions to medications
Problems breathing
The risks for any surgery are:
Bleeding
Infection
Nerve damage
Additional risks include:
Stiffness of the knee
Failure of the surgery to relieve symptoms
Failure of the ligament to heal
Pain in the knee
Weakness of the knee
How do I prepare for an ACL reconstruction?
Plan for your care and recovery after surgery. Allow time to rest, and try to find people to help you for a few days.
Follow your health care provider's instructions. You may be asked not to take aspirin for a week or so before your surgery. Do not eat or drink anything after midnight or the morning before surgery. You may have physical therapy before surgery to begin your rehabilitation.
What happens during anterior cruciate ligament surgery?
You will have either general or spinal anesthesia. A general anesthetic will relax your muscles and make you feel as if you are in a deep sleep. A spinal anesthetic leaves you awake but unable to feel anything from the waist down.
Your doctor will prepare the graft. If your patellar tendon is to be used, the doctor will make an incision 1 to 3 inches below your kneecap. Then he or she will remove your torn ACL using an arthroscope. An arthroscope is a thin tube through which your doctor can view the inside of your knee joint. Various thin, small instruments are used to perform surgery in the knee. Your doctor will drill holes in your femur and tibia where the graft will be attached. The graft will be passed through the holes and anchored in place by screws or staples. The incisions from the graft site and the arthroscopy will be closed with stitches, tape, or staples.
During your surgery, your doctor may also treat any other knee injuries such as torn cartilage.
Will I Need anterior cruciate ligament Surgery?
The most frequently asked question after an ACL injury is, will I need surgery? The answer varies from person to person. Many factors must be considered by the patient and the physician when determining the appropriate treatment. These factors include the activity level and expectations of the patient, whether there are associated injuries, and the amount of abnormal knee laxity, or looseness.
A young patient, who wants to return to competitive sports and has a knee that is very unstable on examination, is more likely to need surgery for a satisfactory outcome than an older patient, who wants to return to recreational jogging and has only mild laxity.
If surgery is not indicated, rehabilitation of the knee begins with exercises to help restore full range of motion. This is followed by strengthening exercises for the muscles around the knee. A return to sports with or without a brace is allowed only after leg strength, balance and coordination have returned to near normal.
What are the signs of an anterior cruciate ligament (ACL)injury?
A patient might hear a popping sound, and won't necessarily feel any pain. The leg may buckle when the patient tries to stand on it. The knee might swell up after the injury.
What causes an anterior cruciate ligament (ACL) injury?
The injury occurs most often if the feet are planted in one direction and the knees are twisted in another. Tears of the anterior cruciate ligament (ACL) of the knee have become an increasingly more common and recognized problem over the past 15 years.
How does a doctor tell if a patient has an anterior cruciate ligament (ACL )injury?
Your doctor will try to move your knee in different directions to see how loose it is and whether it stays in its proper position. An MRI is very accurate in detecting a tear, but looking at your knee internally through a scope may be the only way to tell if it is partially torn.
How is an anterior cruciate ligament( ACL )injury treated?
Advances in diagnostic and surgical techniques have allowed sports medicine physicians and orthopaedic surgeons to more successfully treat patients with torn ACLs. At DHMC, our approach has been to individualize the treatment of patients with ACL tears. Some patients with ACL tears have very little difficulty using their knees normally while others with the same degree of injury frequently have limitations in their activity. There are many critically important variables to consider (such as age, athleticism, expectations) in patients that have torn an ACL. The surgeon must tailor the treatment to each person’s individual circumstances.
The most fundamental problem following a tear of the ACL (once one has recovered from the initial injury) is that the knee is “loose.” The normal ACL restrains the knee in a very small range and this critical restraint is lost following a tear. Some patients will not place high demands on their knee following an ACL tear and are willing to avoid sports such as basketball and soccer and will be happy with nonoperative treatment of their injury. Patients who are active and unwilling to forego participation in activities which place significant stress on their knee will choose to have reconstruction of the anterior cruciate ligament.
Non-Surgical Treatment
For some patients, the doctor may recommend beginning an exercise program to strengthen surrounding muscles. The doctor may also prescribe a brace to protect the knee during activity.
What is the anterior cruciate ligament(ACL)surgery?
The anterior cruciate ligament surgery (ACL) is one of a pair of ligaments in the center of the knee joint that form a cross, and this is where the name "cruciate" comes from. There is both an anterior and a posterior cruciate ligament (PCL). Both of these ligaments function to stabilize your knee from front-to-back. In medical terms, the anterior cruciate ligament surgery (ACL) is the primary restraint to anterior displacement of the tibia on the femur. Translation in plain English, that when the ACL is injured or torn the shinbone can then slide forward on the thighbone, causing the knee to become unstable and “give way”.
Anterior cruciate ligament surgery begins with an arthroscopic examination of the inside of your knee. Arthroscopic surgery has revolutionized the process of ACL reconstruction (and orthopedic sports medicine in general). This surgical technique uses three very small incisions that are about 1/4 of an inch in length to create viewing access into the knee. A fiber-optic light source lights the inside of the knee and a video camera sends an image to a monitor so that the surgeon can see inside the knee. A sterile saline solution is continuously pumped through the knee so that the surgeons vision field is always clear.
During arthroscopic knee surgery, the surgeons maneuver their tools by watching the image (provided by the arthroscope) displayed on a video monitor.
Your surgeon will inspect the knee for damage to the cartilage or the menisci, the remnants of the torn ACL are removed with a shaver. This tool is a special device that is used to remove torn ligaments or torn pieces of cartilage from the knee. The surface of the intercondylar notch where the ACL normally attaches to the femur is then prepared with a high-speed burr so that the proper location for the tunnel. Tunnels are then drilled through the bone in the femur and the tibia so that the graft can be placed in the center of the knee in the same position as the original ACL.
A separate incision that is about 2 to 3 inches long also has to be made in order to harvest the graft from either the patellar tendon or the hamstring tendons. After the graft has been harvested, it is then prepared by placing several very strong surgical sutures through the graft that are used to fix it in place.
After the graft is passed through the tunnels, it is then tightened and fixed into place. A variety of fixation techniques have been developed to anchor the graft to the bone. Different techniques are used for different types of grafts, and today, fixation failures, though possible, are very rare.
Once the graft has been fixed in place and any additional damage has been addressed, the incisions are closed and a sterile dressing is used to cover the knee.
This dressing will remain on for several days.
Four ligaments connect the thighbone (femur) to the shinbone (tibia). The ACL is in the center of the knee and keeps the femur from rotating too far, and from moving too far forward over the tibia.
Why the anterior cruciate ligament surgery Procedure is Performed
ACL reconstruction may be recommended for knee problems such as:
Unstable knee
Knee that gives way
Knee pain
Inability to play sports or other activities
Risks
The risks for any anesthesia are:
Allergic reactions to medications
Problems breathing
The risks for any surgery are:
Bleeding
Infection
Nerve damage
Additional risks include:
Stiffness of the knee
Failure of the surgery to relieve symptoms
Failure of the ligament to heal
Pain in the knee
Weakness of the knee
How do I prepare for an ACL reconstruction?
Plan for your care and recovery after surgery. Allow time to rest, and try to find people to help you for a few days.
Follow your health care provider's instructions. You may be asked not to take aspirin for a week or so before your surgery. Do not eat or drink anything after midnight or the morning before surgery. You may have physical therapy before surgery to begin your rehabilitation.
What happens during anterior cruciate ligament surgery?
You will have either general or spinal anesthesia. A general anesthetic will relax your muscles and make you feel as if you are in a deep sleep. A spinal anesthetic leaves you awake but unable to feel anything from the waist down.
Your doctor will prepare the graft. If your patellar tendon is to be used, the doctor will make an incision 1 to 3 inches below your kneecap. Then he or she will remove your torn ACL using an arthroscope. An arthroscope is a thin tube through which your doctor can view the inside of your knee joint. Various thin, small instruments are used to perform surgery in the knee. Your doctor will drill holes in your femur and tibia where the graft will be attached. The graft will be passed through the holes and anchored in place by screws or staples. The incisions from the graft site and the arthroscopy will be closed with stitches, tape, or staples.
During your surgery, your doctor may also treat any other knee injuries such as torn cartilage.
Will I Need anterior cruciate ligament Surgery?
The most frequently asked question after an ACL injury is, will I need surgery? The answer varies from person to person. Many factors must be considered by the patient and the physician when determining the appropriate treatment. These factors include the activity level and expectations of the patient, whether there are associated injuries, and the amount of abnormal knee laxity, or looseness.
A young patient, who wants to return to competitive sports and has a knee that is very unstable on examination, is more likely to need surgery for a satisfactory outcome than an older patient, who wants to return to recreational jogging and has only mild laxity.
If surgery is not indicated, rehabilitation of the knee begins with exercises to help restore full range of motion. This is followed by strengthening exercises for the muscles around the knee. A return to sports with or without a brace is allowed only after leg strength, balance and coordination have returned to near normal.
What are the signs of an anterior cruciate ligament (ACL)injury?
A patient might hear a popping sound, and won't necessarily feel any pain. The leg may buckle when the patient tries to stand on it. The knee might swell up after the injury.
What causes an anterior cruciate ligament (ACL) injury?
The injury occurs most often if the feet are planted in one direction and the knees are twisted in another. Tears of the anterior cruciate ligament (ACL) of the knee have become an increasingly more common and recognized problem over the past 15 years.
How does a doctor tell if a patient has an anterior cruciate ligament (ACL )injury?
Your doctor will try to move your knee in different directions to see how loose it is and whether it stays in its proper position. An MRI is very accurate in detecting a tear, but looking at your knee internally through a scope may be the only way to tell if it is partially torn.
How is an anterior cruciate ligament( ACL )injury treated?
Advances in diagnostic and surgical techniques have allowed sports medicine physicians and orthopaedic surgeons to more successfully treat patients with torn ACLs. At DHMC, our approach has been to individualize the treatment of patients with ACL tears. Some patients with ACL tears have very little difficulty using their knees normally while others with the same degree of injury frequently have limitations in their activity. There are many critically important variables to consider (such as age, athleticism, expectations) in patients that have torn an ACL. The surgeon must tailor the treatment to each person’s individual circumstances.
The most fundamental problem following a tear of the ACL (once one has recovered from the initial injury) is that the knee is “loose.” The normal ACL restrains the knee in a very small range and this critical restraint is lost following a tear. Some patients will not place high demands on their knee following an ACL tear and are willing to avoid sports such as basketball and soccer and will be happy with nonoperative treatment of their injury. Patients who are active and unwilling to forego participation in activities which place significant stress on their knee will choose to have reconstruction of the anterior cruciate ligament.
Non-Surgical Treatment
For some patients, the doctor may recommend beginning an exercise program to strengthen surrounding muscles. The doctor may also prescribe a brace to protect the knee during activity.
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