ACL Reconstruction
The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope like structure located in the center of the knee running from the femur to the tibia. When this ligament tears, it does not usually heal and often leads to the feeling of instability in the knee.
ACL reconstruction is a commonly performed surgical procedure and with recent advances in arthroscopic surgery can now be performed with minimal incisions and low complication rates.
ACL Reconstruction Hamstring Tendon
Anterior cruciate ligament (ACL) reconstruction hamstring method is a surgical procedure that replaces the injured ACL with a hamstring tendon. The anterior cruciate ligament is one of the four major ligaments of the knee that connects the femur (thigh bone) to the tibia (shin bone) and helps stabilize your knee joint. The ACL prevents excessive forward movement of the lower leg bone (the tibia) in relation to the thigh bone (the femur) as well as limits rotational movements of the knee.
Causes
An ACL injury most commonly occurs during sports that involve twisting or overextending your knee. An ACL can be injured in several ways:
- Sudden directional change
- Slowing down while running
- Landing from a jump incorrectly
- Direct blow to the side of your knee, such as during a football tackle
Symptoms
When you injure your ACL, you might hear a loud "pop" and you may feel the knee buckle. Within a few hours after an ACL injury, your knee may swell due to bleeding from vessels within the torn ligament. You may notice that the knee feels unstable or seems to give way, especially when trying to change direction on the knee.
Diagnosis
An ACL injury can be diagnosed with a thorough physical examination of the knee and diagnostic tests such as X-rays, MRI scans and arthroscopy. X-rays may be needed to rule out any fractures. In addition, your doctor will often perform the Lachman test to see if the ACL is intact. During a Lachman test, knees with a torn ACL may show increased forward movement of the tibia and a soft endpoint compared to a healthy knee.
Pivot shift test is another test to assess ACL tear. During this test, if the ACL is torn, the tibia will move forward when the knee is completely straight and as the knee bends past 30° the tibia shifts back into correct place in relation to the femur.
Procedure
The goal of ACL reconstruction surgery is to tighten your knee and to restore its stability.
Anterior cruciate ligament reconstruction hamstring tendon method is a surgical procedure to replace the torn ACL with part of the hamstring tendons taken from the patient’s leg. The hamstrings are the muscles located on the back of your thigh. The procedure is performed under general anesthesia. Your surgeon will make three small incisions about 1/4-inch-long around your knee. An arthroscope, a tube with a small video camera on the end is inserted through one incisions to see the inside of the knee joint. Along with the arthroscope, a sterile solution is pumped into the joint to expand it enabling the surgeon to have a clear view and space to work inside the joint. The knee is bent at right angles and the hamstring tendons felt. A small incisions is made over the hamstring tendon attachment to the tibia and the two tendons are stripped off the muscle and the graft is prepared. The torn ACL will be removed and the pathway for the new ACL is prepared. The arthroscope is reinserted into the knee joint through one of the small incisions. Small holes are drilled into the upper and lower leg bones where these bones come together at the knee joint. The holes form tunnels in your bone to accept the new graft. Then the graft is pulled through the predrilled holes in the tibia and femur. The new tendon is then fixed into the bone with screws to hold it into place while the ligament heals into the bone. The incisions are then closed with sutures and a dressing is placed.
Risks & Complications
Possible risks and complications associated with ACL reconstruction with hamstring method include:
- Infection
- Blood clots (Deep vein thrombosis)
- Nerve and blood vessel damage
- Failure of the graft
- Decreased range of motion
- Repeat injury to the graft
Post-operative Care
Following the surgery, rehabilitation begins immediately. A physical therapist will teach you specific exercises to be performed to strengthen your leg and restore knee movement. Avoid competitive sports for approximately 6 months to allow the new graft to incorporate into the knee joint.
Anterior cruciate ligament reconstruction is a very common and successful procedure. It is usually indicated in patients wishing to return to an active lifestyle especially those wishing to play sports involving running and twisting. Anterior cruciate ligament injury is a common knee ligament injury.
Other Surgical Options
An ACL reconstruction can also be performed using your patella tendon or an allograft (cadaver graft). Your surgeon will determine your best option.
