Anterior Cruciate Ligament Tear

Anterior cruciate ligament (ACL) tears are a very common knee injury in people who engage in sports. Although ACL injuries occur more frequently in some sports than in others, fundamentally, they can occur in any type of sports activity that places stress on the knee joint.

An ACL tear can result from violent movement of the leg against resistance (e.g. two football players kicking the ball from opposite directions) or from falling on an extended leg. ACL tears often occur in combination with a meniscus, collateral ligament or cartilage injury.
Swelling of the knee is usually immediate and extensive. Normal bending and extension of the knee is no longer possible and usually painful.
When the swelling subsides and it is possible move the leg normally and walk again, you will notice that the knee joint is unstable in certain situations.

If you suspect that you have a torn ACL, first consult your primary care physician, who will perform the initial treatment measures that do not require an orthopaedic specialist. Before referring you to OZM, your doctor may order preliminary imaging studies (MRI scans). An orthopaedic specialist at OZM will first ask you to describe the exact mechanism of the injury and will then perform a thorough examination of the knee. The diagnosis is established based on clinical suspicion of ACL injury in combination with radiographic evidence of damage to the anterior cruciate ligament as seen on a plain radiograph (X-ray) of the knee.
If magnetic resonance imaging (MRI) has not been performed already, this should be done at that point for a more detailed assessment of the knee. MRI allows the specialist to determine whether other structures are damaged.

ACL replacement surgery should not be performed immediately after the injury. Normally, we recommend an initial six-week preoperative rehabilitation programme of physiotherapy in order to maximally strengthen the muscles of the thigh in preparation for surgery. Surgery is then performed after completion of physiotherapy. In some cases, physiotherapy alone will strengthen the thigh muscles enough to alleviate the pain so that it is possible to perform all normal activities of daily living without pain. In this case, surgery can be delayed.

ACL replacement surgery is generally performed under spinal anaesthesia. The advantage of spinal anaesthesia is that it allows the patient to follow the events happening in the operating room. If you would prefer to sleep during surgery, the anaesthesiologist can give you a mild sleep medication in addition to the spinal anaesthesia.
Your anaesthesiologist will meet with you before the surgery to discuss all of this in advance. You can naturally let the anaesthesiologist know your preferences at that time.

After the induction of spinal anaesthesia, the orthopaedic surgeon will examine the affected knee and correct all injuries to the knee during an arthroscopic examination before the actual reconstruction procedure.
Of the different ACL replacement procedures used today, we at OZM have selected the method that is internationally recognised as the gold standard in terms of stability and patient satisfaction. In this procedure, the longitudinal middle third of the patellar tendon is removed together with a small piece of bone on either end (from the kneecap and lower leg bone). We then drill two small tunnels into the thigh and lower leg bone at the sites where the torn ACL normally attaches to the bone. The new ligament with the pieces of bone on either end is then inserted through the tunnels and secured in place.

You will remain in the hospital for a few days during which you will be started on an intensive programme of postoperative physical therapy. Afterwards, you will be discharged home on crutches.
Full weight-bearing with the leg in extension is then permitted.
In the initial period after surgery, you will be required to take medication or injections to thin your blood in order to prevent blood clots and pulmonary embolism.
Physiotherapy is the top priority at this time. The two main goals of physiotherapy are to completely restore the mobility of the knee joint and to further strengthen the thigh muscles.
You will be permitted to walk without crutches in about 4 to 6 weeks. A light sports rehabilitation programme can be started at that time.
Six weeks after surgery, you will be recalled to OZM so that we can re-examine the knee and obtain a follow-up X-ray.
Contact sports (e.g. football) and sports requiring a lot of bending and pressure on the knee (e.g. skiing) should not be resumed until at least 3 months after surgery.