What is ACL Reconstruction?
Anterior cruciate ligament (ACL) reconstruction is a surgical procedure to replace a torn or damaged ACL ligament in your knee with a new ACL tissue graft obtained most commonly from your own body (autograft) or in rare cases from a deceased donor (allograft).
The most common autografts are the patellar tendon (tendon of the kneecap) or one of the hamstring tendons (tendons located at the back of the thigh). In some instances, the quadriceps tendon located above the kneecap is utilized. Tendons are cords of strong fibrous tissue that connect muscles to bones. Ligaments are tough bands of tissue that connect one bone to another bone.
ACL tears or injuries most often occur during sports activities that involve pivoting, cutting, and turning movements as in football, soccer, skiing, tennis, and basketball.
Anatomy of the ACL
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 (thighbone) to the tibia (shinbone). The ACL is one of the four major ligaments of the knee that connects the femur to the tibia and helps stabilize your knee joint. It prevents excessive forward movement of the tibia in relation to the femur as well as limits rotational movements of the knee. When this ligament tears, unfortunately, it does not heal on its own and often leads to the feeling of instability in the knee, requiring reconstruction to correct the abnormality.
Indications for ACL Reconstruction
An ACL tear or injury is the main indication for ACL reconstruction surgery. An ACL injury is a sports-related injury that occurs when the knee is forcefully twisted or hyper-extended. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down suddenly while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also result in injury to the ACL.
Preparation for ACL Reconstruction
In general, preparation for ACL reconstruction surgery will involve the following steps:
- A review of your medical history and physical examination are performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
- You may be asked to stop taking certain medications, such as blood thinners, anti-inflammatories, aspirin, or other supplements for a week or two.
- You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after, as it can hinder the healing process.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You should arrange for someone to drive you home after surgery.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.
Procedure for ACL Reconstruction
ACL reconstruction surgery is usually performed under general anesthesia using a minimally invasive arthroscopic technique. In general, the procedure involves the following steps:
- Your surgeon will make two to three small cuts, about 1/4-inch-long, around your knee.
- An arthroscope is inserted into the knee joint through one of the incisions.
- An arthroscope is a thin tubular instrument with a camera, light, and a magnifying lens attached at the end that is connected to an external monitor and enables your surgeon to view the inside of the knee joint.
- Along with the arthroscope, a sterile solution is pumped into the joint to expand it, enabling your surgeon to have a clear view and space to work inside the joint.
- Miniature surgical instruments are passed through the other incisions and the torn ACL is removed and the pathway for the new ACL tendon graft is prepared.
- Your surgeon makes an incision over the knee or hamstring area and takes out a part of the patellar, hamstring, or quadriceps tendon to prepare the new ACL graft.
- Small holes are drilled into the upper and lower leg bones (femur and tibia) where these bones come together at the knee joint. The holes form tunnels in your bone to accept the new graft.
- The graft is pulled through the predrilled holes in the femur and tibia and fixed into the bones with screws or suture anchors.
- After confirming satisfactory reconstruction, the scope and the instruments are withdrawn, and the incisions are sutured and bandaged.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after ACL reconstruction surgery will involve the following:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic or anesthetic reactions and monitor your vital signs as you recover.
- You may notice pain, swelling, and discomfort in the knee area. Pain and anti-inflammatory medications are provided as needed to keep you comfortable.
- You are advised to keep your leg elevated while resting to prevent swelling and pain.
- You will be given assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
- Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
- Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. A gradual increase in activities is recommended.
- An individualized physical therapy protocol will be designed to help strengthen the knee muscles and optimize knee function.
- You will be able to resume your normal daily activities in a couple of months, but with certain activity restrictions. Full recovery and return to sports usually take about 9 to 12 months.
- You may return to your work in about 6 weeks if your job is not too physically demanding. Those with physically demanding jobs will require a longer recovery period.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
ACL reconstruction surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Pain and weakness in the knee
- Adverse reactions to anesthesia
- Blood clot or deep vein thrombosis
- Damage to adjacent soft tissue structures
- Stiffness or decreased range of motion
- Re-rupture of the graft
- Non-healing of the ligament
Ujenzi wa ACL ni nini? Ujenzi wa ligament ya mbele ya msalaba (ACL) ni upasuaji wa kubadilisha ligament ya mbele ya msalaba iliyovunjika au kuharibiwa katika goti na graft mpya ya tishu ya ACL inayopatikana kwa kawaida kutoka kwa mwili wako mwenyewe (autograft) au katika kesi nadra kutoka kwa mchangiaji aliyekufa (allograft). Vipande vya misuli vinavyopigwa kwa kawaida ni tendon ya patellar (tendon ya kiwiko cha goti) au moja ya tendons za hamstring (tendons zilizoko nyuma ya paja). Katika visa fulani, tendon ya quadriceps iliyo juu ya kiwiko cha goti hutumiwa. Tendoni ni kamba zenye nyuzinyuzi zenye nguvu zinazounganisha misuli na mifupa. Ligaments ni bendi ngumu za tishu zinazounganisha mfupa mmoja na mwingine. Mvunjiko wa ACL hutokea mara nyingi wakati wa shughuli za michezo ambazo zinahusisha pivoting, kukata, na kugeuka kama katika mpira wa miguu, soka, ski, tenisi, na mpira wa kikapu. Anatomy ya ACL: Anterior cruciate ligament ni moja ya ligaments kubwa ya utulivu katika goti. Ni kiungo chenye nguvu kinachofanana na kamba kilicho katikati ya goti, kinachoanzia mfupa wa kiuno (mfupa wa kiuno) hadi mfupa wa kiuno (mfupa wa kiuno). ACL ni moja ya viungo vinne vya mguu vinavyounganisha femur na tibia na kusaidia kuimarisha mguu. Inazuia mwendo wa kupita kiasi wa mbele wa tibia kuhusiana na femur na pia hupunguza mwendo wa mzunguko wa goti. Wakati ligament hii ya machozi, kwa bahati mbaya, haina kupona yenyewe na mara nyingi husababisha hisia ya kutokuwa na utulivu katika goti, inahitaji ujenzi kurekebisha kasoro. Upasuaji wa ACL ni muhimu kwa ajili ya upasuaji wa ACL. ACL ni ugonjwa unaosababishwa na michezo ambayo hutokea wakati wa kugeuza goti kwa nguvu au hyper-extended. Mvunjiko wa ACL hutokea kwa mabadiliko ya mwelekeo wa ghafla na mguu umewekwa ardhini au wakati nguvu ya kupunguza kasi inapovuka goti. Kubadilisha mwelekeo haraka, kuacha ghafla, kupunguza kasi ghafla wakati wa kukimbia, kutua kutoka kwa kuruka kwa makosa, na kuwasiliana moja kwa moja au mgongano, kama vile mpira wa miguu, pia inaweza kusababisha jeraha kwa ACL. Kujiandaa kwa upasuaji wa ACL ni hatua muhimu ambazo unahitaji kufanya kabla ya upasuaji. Kulingana na historia yako ya matibabu, historia ya kijamii, na umri, unaweza kuhitaji kupitia vipimo kama vile kazi ya damu na picha ili kusaidia kugundua kasoro zozote ambazo zinaweza kuhatarisha usalama wa utaratibu. - Utaulizwa ikiwa una mzio wa dawa, anesthesia, au latex. - Lazima umwambie daktari wako dawa zozote au virutubisho unavyotumia au hali zozote unazo, kama vile ugonjwa wa moyo au mapafu. - Unaweza kuombwa kuacha kutumia dawa fulani, kama vile dawa za kupunguza umajimaji wa damu, dawa za kuzuia uvimbe, aspirin, au virutubisho vingine kwa juma moja au mbili. - Unapaswa kuepuka kunywa pombe na tumbaku angalau siku chache kabla ya upasuaji na wiki kadhaa baada ya upasuaji, kwa sababu inaweza kuzuia mchakato wa uponyaji. - Usiwe na chakula au maji angalau masaa 8 kabla ya upasuaji. - Unapaswa kupanga mtu akupeleke nyumbani baada ya upasuaji. - Fomu ya idhini iliyotiwa sahihi itapatikana kutoka kwako baada ya faida na hasara za upasuaji kuelezwa. Upasuaji wa ACL ni kawaida kufanyika chini ya anesthesia ya jumla kwa kutumia mbinu ya arthroscopic chini ya uvamizi. Upasuaji huu una hatua mbili: Mpasuaji hufanya vipande viwili au vitatu vidogo, vya urefu wa inchi 1 au 2 karibu na goti. - Arthroscope huingizwa ndani ya kiungo cha goti kupitia mojawapo ya vipande. Arthroscope ni kifaa cha chini, chenye kamera, taa, na lensi ya kuongeza iliyowekwa kwenye mwisho, ambayo imeunganishwa na mfuatiliaji wa nje na kumwezesha daktari wako kuona ndani ya kiungo cha goti. Pamoja na arthroscope, suluhisho sterili hupomwa ndani ya viungo ili kupanua, kuwezesha daktari wako kuwa na mtazamo wazi na nafasi ya kufanya kazi ndani ya viungo. Vifaa vidogo vya upasuaji hupitishwa kupitia vipande vingine na ACL iliyovunjika huondolewa na njia ya kupandikiza tendon mpya ya ACL huandaliwa. Mpasuaji hufanya upasuaji kwenye knee au hamstring na kuchukua sehemu ya patellar, hamstring, au quadriceps tendon kuandaa graft mpya ya ACL. - Mashimo madogo huchimbwa katika mifupa ya juu na ya chini ya mguu (femur na tibia) ambapo mifupa hii hukutana pamoja kwenye kiungo cha goti. Mashimo hayo hufanyiza mifereji katika mfupa wako ili kukubali kiungo kipya. - Graft huchukuliwa kupitia mashimo yaliyochimbwa mapema katika femur na tibia na kuunganishwa kwenye mifupa kwa vijiti au nanga za kushona. - Baada ya kuthibitisha ujenzi wenye kuridhisha, kipimo na vyombo huondolewa, na vipande hutiwa na kufungwa. Ulinzi wa baada ya upasuaji na maagizo Kwa ujumla, maagizo ya baada ya upasuaji na uponyaji baada ya upasuaji wa ACL utahusisha yafuatayo: - Utahamishwa kwenye eneo la uponyaji ambapo muuguzi wako atakuangalia kwa karibu kwa athari zozote za mzio au anesthetic na kufuatilia ishara zako muhimu unapojipona. - Unaweza kuona maumivu, uvimbe, na usumbufu katika eneo la goti. Dawa za kupunguza maumivu na za kuzuia uvimbe hutolewa kadiri inavyohitajika ili kukufanya uwe na starehe. - Unashauriwa kuweka mguu wako juu wakati wa kupumzika ili kuzuia uvimbe na maumivu. - Utapewa vifaa vya kusaidia kama vile magurudumu na maagizo juu ya kubeba uzito mdogo kwa kipindi maalum cha muda. Unahimizwa kutembea ukiwa na msaada mara nyingi iwezekanavyo ili kuzuia kuganda kwa damu. - Maagizo juu ya utunzaji wa eneo la upasuaji na kuoga yatatolewa ili kuweka jeraha safi na kavu. - Jizuie kufanya shughuli nyingi kwa miezi michache ya kwanza na kuinua uzito mzito kwa angalau miezi sita. Kuongezeka hatua kwa hatua katika shughuli hupendekezwa. - Mkataba wa matibabu ya kimwili ya mtu binafsi utaundwa ili kusaidia kuimarisha misuli ya goti na kuboresha kazi ya goti. - Utaweza kuanza tena shughuli zako za kawaida za kila siku katika miezi michache, lakini kwa vizuizi fulani vya shughuli. Kwa kawaida, kupona kabisa na kurudi kwenye michezo huchukua miezi 9 hadi 12. Unaweza kurudi kazini baada ya wiki 6 ikiwa kazi yako haitoi nguvu nyingi. Wale walio na kazi zenye kudai nguvu za kimwili watahitaji kipindi kirefu zaidi cha kupona. - Mkutano wa mara kwa mara wa kufuatilia utapangwa ili kufuatilia maendeleo yako. Upasuaji wa ACL ni salama, lakini kama ilivyo na upasuaji mwingine wowote, kuna hatari na matatizo kama vile: maumivu ya goti na udhaifu, athari mbaya kwa anesthesia, kuganda kwa damu au uvimbe wa mishipa ya damu, uharibifu wa miundo ya tishu laini iliyo karibu, ugumu au kupungua kwa mwendo, kuvunjika tena kwa graft, au kutoweza kupona kwa ligament.