ACL INJURY

How Does It Happen?

When jogging, athletes frequently suffer ACL injuries when they abruptly halt and shift direction. People who participate in gymnastics, soccer, football, tennis, basketball, or other competitive sports are more prone to inadvertently twist their knees than, distance, cross-country runners who merely advance at a steady pace. Children and adolescents run the risk of stretching or tearing their ACL due to the pace and the manner they bend or straighten their knees. Women are more likely than males to sustain an ACL injury.

What Are the Symptoms of an ACL Injury?

Many people hear a popping sound in their knees when they are injured. But it doesn’t happen to everyone. Some of the more common symptoms are:

Pain

• Children might not experience pain if they only have a slight injury.
• The joint of the knee may be painful.
• Some patients find it difficult to stand or apply pressure on the injured limb.

Swelling

• The first 24 hours is the time when this is most likely to occur.
• By applying ice to the knee and elevating (lifting) the leg by propping it up on a cushion, you can lessen the swelling in your child’s knee.

Difficulty walking

• Walking is more difficult than usual.
• The knee joint might feel looser than it should.

Less range of motion

• Your child probably won’t be able to flex and bend the knee as regularly after tearing the ACL.

How to Prepare for ACL Reconstruction Surgery

Preparing for ACL reconstruction surgery is crucial for a successful procedure and speedy recovery. Here’s a detailed guide on what steps you should take to get ready:

Medical Evaluation

• Review Medical History: Your doctor will review your full medical history. This will help highlight any existing medical issues that need to be addressed before surgery.
• Undergo Necessary Tests: Depending on your background and age, tests like blood work or imaging may be required. These help in identifying any hidden abnormalities that could affect the surgery’s safety.

Discuss Allergies and Current Medications

• Allergy Disclosure: Make sure to inform your healthcare provider about any allergies to medications, anesthesia, or latex.
• Medication and Supplement Review: List all medications and supplements you’re taking. Conditions like heart or lung disease should also be communicated to ensure they are managed properly.

Medication Adjustments

• Medication Instructions: You may be advised to discontinue specific medications, such as blood thinners, anti-inflammatories, or supplements like aspirin, about a week or two before surgery. This helps avoid complications during the procedure.

Lifestyle Adjustments

• Avoid Alcohol and Tobacco: These should be abstained from, starting a few days before the surgery and continuing for several weeks after. Both can interfere with the healing process.
• Fasting Requirements: Avoid eating or drinking anything, starting from midnight before your surgery day, to prepare your body for anesthesia.

Transportation and Legal Consent

• Transportation: Arrange for someone to drive you home after the surgery, as you’ll be unable to drive yourself.
• Informed Consent: Before the surgery, you’ll need to sign an informed consent form. This ensures you understand both the benefits and potential risks of the procedure.

By following these steps, you’ll set the stage for a smooth surgical experience and recovery. Make sure to consult your medical team if you have any questions or need further clarification.

What’s the Treatment for an ACL Injury?

Depending on how severely your child was injured, here are a few possibilities our doctor could suggest to the parent:

Initial care. If your child’s injury is minimal, elevate your child’s leg, apply ice to your knee, and keep him or her sitting or lying down.  By compressing your knee with an Ace bandage, you can lessen swelling. Crutches might assist in removing weight from your child’s knee.

Medications. Anti-inflammatory medications can aid in reducing pain and swelling. Our doctor may advise over-the-counter drugs or prescribe a stronger prescription. Our doctor could inject steroid medicine into your child’s knee if the pain is severe.

Knee brace. Some children with an injured ACL can continue to run or participate in sports while wearing a brace on their knee. It offers further assistance.

Physical therapy. To restore your child’s knee functionality, your child could require physical therapy a few days each week. The exercises your child undergoes will help restore a complete range of motion by strengthening the muscles around the knee.

Surgery. Our doctor may say your child needs surgery if he or she has a severely torn cruciate ligament or if the child’s knee hurts when walking. Surgery will replace the damaged tissue so that new ligaments can grow in their place. With physical therapy, people who have had surgery can often resume exercising within 12 months.

What Is ACL Injury Surgery?

ACL surgery is a procedure doctors use to replace torn ligaments in the knee. When it strains or rips, it sustains an injury. Our doctor will replace your child’s damaged ACL with a tendon after removing it. (Tendons attach muscle to bone). The objective is to restore your child’s knee stability and give it the complete range of motion it had before the injury. A graft occurs when a tendon is implanted into your child’s knee. With ACL surgery, three different graft types may be utilized:

Autograft. A tendon from another part of the body is used by the doctor (like the other knee, hamstring, or thigh).

Allograft. This kind of transplant utilizes an external source of tissue (a deceased donor).

Synthetic graft. This is the time when synthetic materials take the place of the tendon. Silk and silver fibers were among the first ones utilized (in the early part of the 20th century). Although there are now more sophisticated possibilities like Teflon and carbon fiber, researchers are still trying to identify the optimum material to replace ACLs.

ACL Surgery Procedure

To repair an ACL, doctors frequently use arthroscopic surgery. They do this by making small incisions around the knee, then inserting tiny instruments and a camera. Compared to open-knee surgery, this procedure leaves fewer scars. The procedure takes about one hour to complete.

In order to prevent your child from feeling anything in their legs for a few hours after surgery, our doctor may choose to use a local anesthetic rather than general anesthesia, which would put your child to sleep throughout the procedure. If a local anesthetic is used, your child will probably also be given medication to calm them while the treatment is being done.

Surgical Procedure

• Incisions and Arthroscope Insertion: Your surgeon will make two to three small cuts around the knee, each about 1/4-inch long. An arthroscope—a thin tubular instrument with a camera, light, and magnifying lens—is inserted into the knee joint through one of the incisions. This is connected to an external monitor, allowing the surgeon to view the inside of the knee joint clearly.

• Joint Expansion: A sterile solution is pumped into the joint to expand it, which provides a clear view and space to work inside the joint.

• Graft Preparation: The surgeon will remove a section of the patellar, hamstring, or quadriceps tendon to prepare the new ACL graft. This is a crucial step in ensuring that the graft is ready for placement.

The first step is to place the graft in the proper location. Tunnel Creation: Doctors then create two holes, known as “tunnels.” One tunnel is drilled in the upper knee bone (femur), and the other in the lower bone (tibia). These tunnels serve as pathways for the new graft.

• Graft Placement and Fixation: The graft is pulled through these predrilled tunnels and is secured with screws or buttons. This acts as a bridge for new ligaments to grow as it heals. It may take several months for the new ACL to fully integrate and grow.

After surgery, most patients can leave the hospital on the same day. Our doctor will ask your child to step very lightly on the leg with the injured ACL, rest the knee, and wear a brace to protect the joint as it heals. This comprehensive approach ensures a successful recovery process.

Additional Knee Procedures Related to ACL Reconstruction

When considering knee procedures beyond ACL reconstruction, a variety of surgeries and treatments are available to address different aspects of knee health and recovery. Here’s a breakdown:

Reconstructive Surgeries

• Tibial Osteotomy: Often used to realign the knee and relieve pressure on the joint.
• Patellofemoral Stabilization: Aimed at stabilizing the kneecap to prevent dislocation.
• Meniscal Surgery: Includes repair or removal of the damaged meniscus.
• Posterolateral Corner Reconstruction: Restores stability to the outer side of the knee.
• Medial Patellofemoral Ligament Reconstruction: Reinforces knee stability, especially at the kneecap.
• LCL and MCL Reconstruction: Targeting the ligaments responsible for side-to-side movement.

Repairs and Transplants

• Meniscal Transplantation Involves replacing a damaged meniscus with donor tissue.
• Quadriceps Tendon Repair: Fixes tears in the tendon that connects the quad muscle to the knee.
• Cartilage Restoration: Techniques like microfracture surgery improve or restore knee cartilage.

Specialized Procedures

• Knee Osteotomy: Sometimes performed to correct alignment and alleviate arthritis.
• Knee Ligament Reconstructions: Covers various ligament repairs, including revision surgeries if previous reconstructions fail.
• ACL Reconstruction Options: Utilizing different tendons like the patellar or hamstring for grafts.

Injections and Non-Surgical Treatments

• Viscosupplementation: Involves injecting hyaluronic acid-based products to lubricate the knee joint.
• Intraarticular Knee Injection: Often used for pain relief and inflammation reduction.
• Physical Therapy: Essential both pre- and post-surgery to enhance recovery and maintain joint function.

Each of these procedures has its unique focus and can be considered based on specific knee conditions and individual patient needs.

Medical Research for an ACL Injury

Researchers are also working with physicians to determine if a novel approach to ACL surgery is superior to current treatments. Bridge-enhanced ACL Repair (BEAR) is the name of the new procedure. BEAR, in contrast to conventional ACL surgery, encourages the injured ACL to mend on its own without the need for replacement. Between the ACL tears in the knee, doctors place a specific, small sponge. The doctors then sew the frayed, loose ends of the ACL into the sponge after injecting it with your child’s blood. It serves as the ACL’s support. The damaged ends eventually mend and regenerate into brand-new, sound ACL tissue.

ACL Surgery Risks

ACL surgery carries dangers, just like any other form of surgery. In general, surgery might result in:

• Bleeding at the wound
• Infection
• Shock
• Blood clots
• Breathing issues
• Trouble peeing
• Reaction to anesthesia

With ACL surgery, in particular, the threats include:

• Knee pain
• Stiffness in the knee
• A graft not healing well
• A graft failing after your child returns to physical activity

ACL Injury Surgery Recovery

You’ll receive instructions on how to change the dressing on your child’s wound before you leave the hospital. Our medical staff will advise the parent to keep the affected knee elevated on cushions, apply ice to it, and bandage it. To relieve the strain on your child’s knee, he or she should use crutches. Our doctor may prescribe medicine to treat pain, such as:

• A nonprescription drug such as acetaminophen, ibuprofen, or naproxen
• Prescription medications

Finally, as previously mentioned, our doctors at the Medical City Children’s Orthopedics and Spine Specialists, with offices in Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX, will recommend physical therapy as the ACL starts to heal. That will support the muscles and ligaments in becoming stronger. After that, your child ought to be able to resume his or her favorite activities in roughly nine months. For athletes, it may take up to a year before they may resume their sport.

What to Expect During Recovery:

• Initial Recovery: You will be able to resume your normal daily activities in a couple of months but with certain activity restrictions to ensure proper healing. This period is crucial for laying the foundation for a successful recovery.
• Full Recovery: Full recovery and a complete return to sports usually take about 9 to 12 months. This timeline allows for comprehensive healing and strengthening of the knee, ensuring a return to pre-injury performance levels.

By integrating structured physical therapy and adhering to recommended restrictions, your child will navigate the recovery process effectively, minimizing risks and fostering a strong comeback.

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Footnote:

Medline Plus:  ACL Injury