“Individual” surgery and rehabilitation of the anterior cruciate ligament

If Sunday’s match ended unexpectedly fast, and your ski vacation has caused you an injury … You have been diagnosed with a torn anterior cruciate ligament in your knee, then this article is just for you. In it I want to inform you about:

  • the latest trends in the choice of autoplants in orthopedics and traumatology and the pursuit of “individual” surgery;
  • the tendency to increase the terms for recovery with physiotherapy and rehabilitation in order to avoid recurrences.

Introduction to the topic

Anterior cruciate ligament is an important stabilizer in the knee joint. It is most often damaged by hyperextension of the joint. And the sports associated with this ligament injury are skiing and football. ACL’s own regenerative abilities are very weak, so very often young, active sports individuals need surgical reconstruction.

Restoration of ACL is done with arthroscopic surgery requiring 3 point incisions and a longitudinal incision in the donor site of the autograft.

In the reconstruction of ACL with a graft from the patellar tendon, the torn ligament is completely removed and tunnels are drilled in the bone of the lower leg / tibia / and the femur. If the intercondylar chute is narrowed, it widens. From the medial third of the patellar tendon, a tendon graft is taken together with its bone insertions and placed in the place of the removed ACL, passing through the made bone tunnels. If a graft is taken from the hamstring tendons, the incision is in the area of ​​the tibial muscle insertion. The graft is fixed with screws without heads. The bone donor part is filled with the bone substance removed during the drilling of the femur and lower leg. Precise anatomical placement of the implant is of particular importance, as its displacement can cause a reduction in the volume of movement postoperatively. The same applies to its tension – if it is too relaxed it will cause looseness in the joint, and if it is tense – it will reduce the volume of movement.

“Individual” and not “universal” surgery

The trends are in precise analysis of:

  • the constitution of the patient’s body;
  • the type of muscle of the patient;
  • the requirements to the physical activity and the sports load of the patient;
  • is the knee injury combined / ie. whether other intra-articular structures are also affected /.

All these factors must be taken into account when choosing an operative technique in order to achieve the best results. This is meaningful, important and defining for the patient. The operative approach to a fifty-kilogram ballerina with graceful muscles or an active athlete with well-developed muscles or a non-athlete who has been injured by a fall of the ice will be radically different. This depends solely on the experience of the surgeon.

As a physiotherapist with a practice in sports and rehabilitation, I advise you to move the knee with several physiotherapy procedures. This will reduce swelling and pain and raise muscle tone. This will also open the door to postoperative physiotherapy.

Physiotherapy after anterior cruciate ligament reconstruction

In hospital conditions, physiotherapy can begin on the first postoperative day with arthromotor and electrical stimulation. Exercises are gradually added to the program. It is expected that between 21 and 30 days you will remove the crutches and the splint, if you have one. This is followed by building strong thigh muscles with strength exercises. This is followed by adaptation of the knee to running and in later stages to a specific sports activity.

You can find many rehabilitation protocols after ACL accelerated for athletes and non-accelerated. Experienced therapists are not guided by protocols. The load is approached individually, observing the principle of calm joints and well-loaded muscles. Patients attend physiotherapy 2-3 times a week, with a tendency to decrease once a week and consultatively when changing the load in the training program.

News regarding the rehabilitation

The XX International Conference on Sports Medicine brought together the three presidents of the Balkan Association of Arthroscopy, Sports Traumatology and Knee Surgery and sparked a discussion on the timing of recovery. Recently, operative techniques have allowed early exercise, adaptation and return to sports gradually after the sixth month.

The highlights of the discussion were three:
  • the vascularization of reconstructed ACL and the creation of a capillary network begins only 4-5 months after the operative intervention;
  • risk of loosening of the auto graft in case of early inclusion of more serious loads / for example: running /, which would increase the slackness in the joint;
  • increased number of relapses according to statistics worldwide.

https://www.arthroscopyjournal.org/article/S0749-8063(05)80313-5/pdf

All these surgeons with extensive clinical experience shared their observations and were unanimous that no one can “overtake nature”. This means that highly elite athletes and active sports patients athletes should be under the supervision of doctors and physiotherapists for longer – 8 months to a year, in order to maximize the functional recovery of the limb.

Conclusion

Advice:

  1. Discuss the operative technique carefully.
  2. If it is not contraindicated, do preoperative rehabilitation.
  3. Be patient … Complete postoperative rehabilitation can take up to a year.

We wish you good Luck 🙂

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