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Advanced ACL Reconstruction
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ACL Reconstruction

What is ACL?

One of the most crucial ligaments in the knee is the ACL, or anterior cruciate ligament, which keeps the shinbone from sliding over or in front of the thigh bone and stabilises the knee joint.

What is ACL Tear?

Sports involving actions like leg pivoting, cutting, and planting as well as those that could result in an impact on the knee are more likely to cause anterior cruciate ligament injuries. This increases the risk of ACL damage in athletes who play basketball, soccer, football, skiing, etc.
An ACL tear is a partial or complete rupture of the anterior cruciate ligament. The tear can be brought on by both touch and non-contact traumas, and its severity can range from minor to severe. Extreme movements or injuries are major causes of ACL tears in athletes and sportspeople, however women are more prone to this ailment than males are. ACL tears require specialised medical care since they cannot mend on their own.

Causes

  • Jumping and landing poorly
  • Turning the leg
  • Running with leg planting and cutting, then suddenly slowing down and stopping
  • Rotating the leg swiftly and excessively

Symptoms

  • The knee making a popping noise
  • Acute pain
  • Affected knee and leg immobility
  • The knee’s inability to support weight
  • Swelling and inflammation within the first 24 hours.

Diagnosis

When an ACL rupture is suspected, it is advised to seek prompt medical attention because the type of injury determines the severity and course of therapy. A medical professional will check the knee for indications of discomfort, inflammation, and swelling. Passive motion tests will be used to assess the knee’s strength and range of motion.
Physical examinations will assist the doctor in determining the severity of the injury and whether the condition is actually an ACL rupture. The Lachman’s Sign test is frequently chosen for this reason. The procedure for the test is as follows.

Lachman’s Sign Test:The patient is instructed to lie on his or her back and relax the affected limb for the Lachman’s Sign Test. The examiner holds the leg by supporting the lower thigh with one hand and the upper calf with the other. The calf is lifted forward and the knee is softly bent to around a 30 degree angle.

The exam is conducted on both knees for comparison. The patient’s ACL is probably torn if the injured knee has a wider range of motion than the unaffected one. Other tests could be carried out to verify the diagnosis. These examinations might involve:
X-rays: While they cannot reveal ligament damage, they can reveal if there is a bone-related injury as well.

Magnetic resonance imaging: A clear image of the anterior cruciate ligament can be obtained during a knee MRI scan, which can also assist in the diagnosis.

SEVERITY

Grade I

The overstretching of the ligaments results in little injury.

Grade II

When a ligament is severely stretched or hit hard, it becomes loose. Partial ACL tears are regarded as Stage 2 injuries.

Grade III

A whole or complete ACL tear is the term used to describe it. The knee joint becomes unstable and immovable as a result of the ligament rupturing into two parts.

Risk and complications

Risk Factors

Anyone can have an anterior cruciate ligament injury, however some people are more susceptible to one than others due to a few risk factors. Such elements could be:

Gender: Female athletes suffer three times as many ACL injuries as men athletes do. While the precise reason of this cannot be determined, variations in the structure, functionality, and strength of the muscles may be to blame.


Sports: Sports that need the leg to be planted, rotated, or pivot are more likely to cause an ACL tear than those that could lead to collisions or impacts. Football, volleyball, soccer, basketball, lacrosse, tennis, and other sports may fall under this category.


Age: Although ACL tears can occur at any age, those between the ages of 15 and 45 are the most susceptible due to their propensity to play competitive sports.


Injury history: If an ACL tear has previously occurred, the risk of another tear rises by 15%. According to studies, the first year following an initial injury is when ACLs are most likely to tear.

The consequences of an untreated ACL tear

If treatment is put off or avoided, the symptoms of an anterior cruciate ligament tear will only get worse. Leaving an ACL injury untreated can have serious repercussions, which can lead to the following circumstances.

Untreated ACLs become extremely unstable and are unable to support any bodyweight, causing knee instability. An injury to the anterior cruciate ligament causes the knee to buckle out, snap, or catch and prevents one from completing simple actions like walking. The anterior cruciate ligament is important for stabilising the knee.

Pain: One of the initial signs of an ACL injury is severe discomfort. If the disease is not treated, this symptom will only get worse. Small meniscus rips in the knee expand with time, and in some cases the agony from these developments makes the knee immobilised.
Disability: If injuries like ACL tears are not adequately and promptly treated, they eventually rupture completely. If the issue worsens over time, the joint will eventually lose its ability to bend or straighten, making it impossible for the patient to usually walk or stand.
Arthritis: A torn ACL is quite painful and weakens the knee if left untreated. This prevents normal joint movement, which in turn causes other tendons, tissues, and bones to make up for it. Such a shift in biomechanics can increase the patient’s chance of developing osteoarthritis and induce wear and tear on the knee cartilage.

Surgical ACL Reconstruction Risks and Complications

ACL Reconstruction surgery has some inherent risks and consequences, just like any major procedures. Any major operation carries a number of potential dangers, such as those related to excessive bleeding, blood clotting, infections, allergic reactions to anaesthesia, postoperative problems, etc.
These are a few complications that are directly linked to ACL reconstruction surgery.
Nervousness in the leg or foot
Instability in the leg or foot
a smaller range of motion
Kneecap inflammation and persistent pain
stiffness and swelling in the afflicted knee
The damaged knee is unstable.
Injury to blood vessels, nerves, or muscles
Growth plate damage that the graft is unable to heal
Infection with HIV or hepatitis if an allograft is used
With a success rate of more than 80%, ACL reconstruction surgery is the gold standard for treating damaged ACLs. Before making a choice, it is best to go over all the possible hazards with your doctor.

ACL injuries and tears: Myths and Reality

Myth: Only blunt force damage in sports results in ACL rupture.
Facts: ACL tears can occur to anyone at any time, however they seem to happen more frequently in sports or accidents.
Myth: To perform ACL reconstruction surgery, the knee must be cut open.
Fact: Factual statement: As opposed to modern arthroscopic ACL reconstruction surgery, traditional open operations required cutting open the knee.
Myth: The knee will bear noticeable scarring from ACL restoration surgery.
Fact: Small incision minimally invasive procedures are used to do ACL reconstruction surgery. No significant scars are left on the knee as a result.
Myth: If your ACL tears, you’ll have to stop playing sports.
Fact: With the aid of physiotherapy and exercise, you will be able to resume sports in due course after fully healing from an ACL repair operation.
Myth: Men sustain ACL injuries more frequently than women.
Fact: According to studies, women have a three to four times higher risk of tearing their ACL.

Treatment Options

Treatment of ACL tear and Injuries

To treat the symptoms of a knee injury, one should immediately use the RICE approach. The RICE approach includes:
Rest: Until the symptoms subside, avoid activities like walking, running, or standing.
Ice: To assist relieve the discomfort and swelling, applying ice to the affected area is advised. You can carry out this throughout the day for 20 to 30 minute intervals.
Compression: Applying a tight, elastic bandage to the injured knee can reduce swelling and inflammation.
Elevation: Maintaining the knee elevated above the waist can aid in controlling knee swelling.

Your doctor will classify the ACL tear as a Grade 1 injury if it is not serious and may be managed nonsurgically. For ACL rips, nonsurgical options include:
putting on a knee brace to provide stability and support
undergoing physical therapy to regain knee range of motion.
Using nonsteroidal anti-inflammatory medications on prescription to treat pain
Nonsurgical treatment options are available for ACL strains and minor injuries, but they are ineffective for managing more serious injuries. An ACL tear that is a grade 2 or 3 requires surgery to repair the torn ligament. The least intrusive ACL restoration surgery is the most popular procedure for accomplishing this.

ACL Reconstruction Surgery

Surgery arthroscopy is used in minimally invasive ACL reconstruction, which speeds up healing compared to open surgery. Smaller incisions are used in these treatments to reduce trauma at the surgical site.
The anterior cruciate ligament cannot mend on its own and, if damaged, cannot be repaired. As a result, a tissue transplant is used to restore the ACL during an ACL repair. The patient’s hamstring tendon, the quadriceps tendon in the back of the thigh, the patellar tendon between the kneecap and the thigh, and the shinbone and kneecap can all be used as sources for the tissue graft.
An allograft tissue transplant may also be possible in specific circumstances.
Each graft has advantages of its own and can serve as a scaffold for the development of a new ligament.

ACL Reconstruction Surgery Procedure

Two or three tiny incisions are made at the side of the knee during a minimally invasive ACL restoration procedure. Through one of the incisions, an arthroscope—a tool with a camera at its end—is introduced, and a clear image of the interior of the knee is displayed on a screen.
Surgical instruments are placed through a second incision in order to repair the ligament and remove any damaged tissue. Following the procedure, the knee joint is cleaned with a sterile solution, and the wounds are repaired.

Cost of Treatment of ACL Reconstruction

Between INR 1,50,000 and INR 2,50,000—including the expense of hospitalisation and post-operative care—can be spent on an ACL reconstruction procedure. The cost of the procedure is mostly influenced by things like the general hospital costs, the surgeons' fees, the type of anaesthetic utilised, and underlying problems like liver, lung, or heart diseases, among other things.

Surgery to rebuild the ACL is covered by insurance

When nonsurgical therapy options have failed and there are no practical alternatives, patients are advised to undergo ACL reconstruction surgery. The majority of insurance companies will pay for an ACL reconstruction procedure to fix a partial or total anterior cruciate ligament damage.
However, the specifics of insurance coverage depend on the individual's insurance contract. We accept the majority of the main health insurance programmes, such as Star Health Insurance, New India Health Insurance, Bajaj Allianz, Religare, and ICICI Lombard, among others. We also provide customers who want financial assistance a No Cost EMI Option.
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