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How is ACL (anterior cruciate ligament) treated? – Part 1

• Patients who have suffered an ACL injury also need to be evaluated for other knee injuries.
• Such injuries are typically seen in combination with a tear caused due to ACL.

Such injuries for which the patient needs to be evaluated includes:
• Bone bruises
• Posterior Cruciate Ligament (PCL) tears
• Cartilage injuries
• Meniscus injuries
• Collateral ligament injuries
• Poster lateral injuries

Some more details about ACL and Treatment:
• The tear caused in ACL will interrupt knee movement, and this leads to the need for priority treatment of tears in ACL.
Why priority treatment ? If tear in ACL is not attended to quickly, the femur and tibia bone can rub against each other, leading to severe damage to the cartilage of the knee. In case of ACL tear, what is recommended medically is that immediate rest should be given to the torn knee.
• In order to provide some compression on the ice, it is recommended to apply ice on the knee at a period of every 15 to 20 minutes. Once this done a few time, the next step is to elevate the knee such that the level is above that of the heart.
• Doing this helps to decrease the swelling and also helps to reduce the pain being caused due to the tear.
• For treating a tear of the ACL, depending on the severity of the tear and the impact on the ligament, different treatments can be employed.
• Smaller tears need less months than larger tears in order to heal the muscles. For the muscles to become strong again, muscles need to have rehab.
• As a part of having a healthy knee, other muscles that need to be strong are the hamstring and quadriceps. Having these muscles to be stronger means that these will compensate for the ligament.

When to do surgery?

• When the severity of the tear is large and just rehab is not enough, then doctors turn to surgery and it is the only option. The surgery that is carried out on the tear would help the healing of tear.
• The reason for surgery is also because when there is a tear, blood supply to the ligament may get stopped. This surgery is very important if the patient is very active, especially if the person is a sports-person.
• The ligament has a vital role in facilitating sharp movements of the knee while ensuring safety and stability – very very important for sports-persons.
• Surgery carried out for this purpose is called reconstructive surgery and is typically carried out several weeks after the injury has happened. This time period is to ensure that the pain and swelling in the knee has reduced, necessary to carry out the surgery.
• During surgery, contrary to what people think, the ACL is not repaired, instead a reconstruction happens using other ligaments taken from the body, from other areas.

Types of ACL surgery (3 types)

• Patella tendon-bone auto graft
• Hamstring auto graft
• Allografts

1. Patella tendon-bone auto graft
• This ACL surgery is typically the most common type of surgery, and not surprisingly, is also the most preferred type of surgery.
• The central 1/3 portion of the patella tendon is removed along with a small piece of bone at the attachment sites.
• The attachment sites are on the kneecap and tibia.

Advantages of Patella tendon-bone auto graft
– The patella tendon and ACL have approximately the same length.
– This uses a bone to bone attachment.
– This surgery is the most common and preferred primarily because the attachment is considered much stronger than other healing methods.

Disadvantages of Patella tendon-bone auto graft
– Common anterior knee pain, caused due to the grafted piece of bone, the removal of bone from the kneecap.

2. Hamstring auto graft
• In this type of surgery, the two tendons are taken from the hamstring muscles and then wrapped together to form a new ACL.

Advantages of Hamstring auto graft
– Since there is no bone removal, there is a reduction of post-surgery pain.
– In addition to a reduction in pain, the healing is smoother than that of the patella tendon-bone graft.
– The incision made is very small.

Disadvantages of Hamstring auto graft
– The new ligament takes longer to heal since there is no bone to bone healing.
– In addition to the longer time for ligament to heal, the tendon to bone connection takes longer to become rigid.
– After this type of surgery, rehabilitation is essential in order to strengthen the surrounding muscles.
– As a part of this surgery, it is required to stabilize the joint.

The ACL Solution Anterior Cruciate Ligament (ACL) Strength and Conditioning: Biological Principles and Practical Applications

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