This important ligament connects the hip bone (femur) with the shin bone (tibia), balancing and stabilizing the bones. The ACL is located in the center of the knee and creates an X shape together with the Posterior Cruciate Ligament (PCL).
Torn knee ligament
Tearing a knee ligament may occur very suddenly upon a sudden twisting of the knee, accompanied with a sudden, powerful cramping of the quadriceps muscle (quad). The injury will feel a tearing sensation, as if the knee “giving way”. During trauma, the meniscus or cartilage may be injured as well. This is a serious knee injury, which will prevent athletes from returning to normal activity. Left untreated, incidents of the knee “giving way” may re-occur, causing more damage to additional areas of the knee such as the cartilage or meniscus, eventually expediting degenerative changes - known as knee arthritis. The shape of the knee and the joint fluids will not allow the ACL to spontaneously rehabilitate and reattach itself.
Every ACL tear requires using the knee and rehabilitating it. Injured individuals must alter their habits, or otherwise seriously consider an ACL Reconstructive Surgery.
Reconstructive ACL Surgery
ACL reconstructive surgery is performed by arthroscopy, with only the smallest incisions to the skin, and without opening the knee joint.
An implant must be attached in place of the torn ligament. For this purpose, 2 types of implants may be used:
A self implant, taken from the knee cap (patella) tendon along with fractions of bone. Another option for self implant is from flexor tendons from the thigh, typically from the same leg.
Another option is an implant from an organ bank called allograft.
Normally, and in particular in the case of healthy young individuals, Dr. Suzanna Horovitz prefers a self implant, since this type of implant is stronger, more durable, and has greater chances of being accepted.
The implant is prepared for insertion, then a knee arthroscopy is performed, accompanied by repairing any damage to the meniscus or cartilage. Using special tools, small channels are drilled into the two bones of the knee, through which the implant is inserted , in such a way that the location of the implant will match the correct anatomical position of the original ligament, as it was prior to injury. After inserting the implant through the drilled channels, it is fixed on both ends by pins or screws. Typically, this implant will never need to be removed.
Pre surgery preparation
Tearing the ACL is a serious knee injury, and the patient has difficulty returning to performing the same ranges of motion as prior to injury., particularly if the tear is followed by swelling of the knee.
Therefore, Dr. Suzanna Horovitz recommends to wait with the ACL reconstruction until swelling and inflammation is reduced, and until ranges of motion return to normal, otherwise it will be difficult to return to the same ranges of motion, due to the inflammation.
Dr. Suzanna Horovitz also typically recommends to begin strengthening and balancing the leg before surgery, in order to improve and alleviate post surgery rehabilitation.
Post surgery, rehabilitation treatment
After surgery, the patient will remain hospitalized overnight, with a cooling bag keeping the operated knee cool.
Due to advancements in surgical technique and medical equipment available today, Dr. Suzanna Horovitz believes in expedited knee rehabilitation process which allows patients to return to their active life in a relatively short period. Accordingly, as early as the first day after surgery, the patient will begin physiotherapy with a certified physiotherapist, in order to achieve maximum results for the knees, according to an established rehabilitation protocol, with the goal of enabling the rehabilitation of the knee’s stability, and without injuring the reconstructive implant. The same day the patient will begin walking, fully stepping on the operated leg.
Except for performing rehabilitative activities, the knee is fixed in a splint during the first two weeks after surgery, particularly during rest, in order to allow the patient to maintain their ability to fully extend their knee from the beginning of rehabilitation.
The small scars which are left after the surgery will be sealed with surgical pins for two weeks, and then removed by the doctor or by a nurse.
To prevent infection, the patient will be treated with antibiotics once before surgery. In order to keep the small wounds clean, the patient may remove their own bandages as early as two days after surgery, and wash with water and soap. Baths are allowed only after two weeks have passed since surgery.