Arthroscopic ACL surgical treatment is done to repair a partially or completely torn anterior cruciate ligament(ACL). ACL wounds account for about 40% of all sporting injuries and can lead to long-term pain and instability. There are two types of ACL knee surgery commonly performed depending on the severity of the damage, ACL repair surgery or an ACL reconstruction.
In most cases, ACL knee surgery is performed arthroscopically these days. Through Small holes, a special camera and Surgical tools are inserted into the knee in this Arthroscopic surgical process.
It is usually referred to as “keyhole surgery”. The big advantage is that the surgeon can assess the joint and repair any injuries without fully opening the joint. This speeds up recovery due to less trauma to the knee.
What Is An ACL Injury?
Arthroscopic ACL surgery is recommended when there is significant damage to the ACL. The ACL (anterior cruciate ligament) is one of a pair of ligaments in the mid of the knee joint, responsible to provide stability. It is a very strong ligament but if it gets overstressed, the fibres start to tear. With enough force, it can rupture completely.
ACL injuries are generally caused by:
1) Sudden, awkward movements of the knee e.g. winding the knee or overextending it
2) Direct blow: to the outside of the knee when the foot is fixed to the ground e.g. in sportsmen wearing studs
3 grades of ACL injury:
Grade 1: The ligament is overstretched and less than 10% of the fibres are torn. Should heal naturally in a few weeks.
Grade 2: Ligaments are intact when most of the fibres are torn. May heal with a rehab programme or may require arthroscopic ACL surgery.
Grade 3: The ligament is completely ruptured i.e. torn in two. Usually requires arthroscopic knee surgery.
Types of Arthroscopic ACL Surgery
Arthroscopic ACL surgery is performed to resume the stability of the knees.
2 types of Operation to treat ACL injuries and both are done arthroscopically.
1) ACL Repair Surgery:
Arthroscopic ACL repair surgery is performed when the muscle is broken off from the bone (called as an avulsion). The ligament is reattached to the bone and held in place. Repair is sometimes done if the ligament is partially torn. The surgeon sews the ligament back together in order to heal. However, there is a high failure rate so in most cases, it is better to go for a reconstruction than repair.
2) ACL Reconstruction:
If there is more significant damage or ongoing problems with pain and instability, the torn muscle is removed and replaced with an implant, generally taken from your hamstring or patellar tendon.
A reconstruction is much more common than a repair.
Preparing for Surgery
Performing Operation too quickly is coupled with an increased failure rate due to re-rupture of the new transplant. Your Physician will probably want you to wait until:
1) The swelling is reduced
2) You regain full range of movement at the knee
3) You build up the strength of the quadriceps and hamstring muscles
They may refer you to physio before your operation to urge you started a rehab programme. This will also have a positive impact on the recovery process.
What Happens During Surgery?
With both forms of arthroscopic ACL surgery, 2 or 3 small slits are made at the side of the knee. A special camera (known as an arthroscope) is inserted through one hole so that the surgeon can see the level of the damage. Special tools (such as scissors or lasers) are then inserted through the other hole and used to repair or replace any damaged tissue.
What Happens After Surgery?
Arthroscopic ACL surgery is not a fast fix. Both procedures require a few months of rehab to make up the strength and stability of the knee.
Do I Need Surgery?
Many people recover from ACL injuries without any need for arthroscopic ACL surgery, even some people with the completely ruptured ligament. It essentially comes down to 2 things, how severely the stability of the knee has been affected and what activities the affected individual does to become normal.
Arthroscopic ACL surgery is therefore indicated in individuals who:
a) want to return to pivoting sports e.g. football, skiing, tennis, rugby, boxing or hockey
b) suffer problems of instability with their knee giving way during their everyday activities
Alternatives to Surgery
Not everybody whose ligament ruptures goes for an arthroscopic ACL surgery. Exercise rehabilitation for fully or a partially torn ACL appears to make up the strength of the knee ligaments so that they can supply enough stability and support for the knee to compensate for the torn ACL. It additionally helps train the muscles and other ligaments to supply proprioceptive feedback to gain more stability. It normally takes a few months of rehab to completely recover from a torn ACL.
Wearing an ACL knee brace might facilitate support and protection to stop the knee from giving way.