ACL/PCL RECONSTRUCTION
Reconstruction
Anterior Cruciate Ligament (ACL)
Causes
Symptoms
ACL tears typically result in immediate pain and often lead to swelling. You might experience a sensation of something "popping" inside the knee. Initially, you may find it difficult to bear weight on the affected leg, although this discomfort may diminish, and walking could become feasible after a few minutes. The knee may feel unstable or as if it might give way, making it impossible to return to sports activities. As time passes, swelling tends to worsen, and you may experience a decrease in range of motion.
Diagnosis
Your surgeon will conduct a comprehensive assessment, including a detailed history and physical examination along with X-rays. During the examination, they will observe swelling, as well as detect limitations in motion and strength. The surgeon will also perform specific maneuvers to assess the stability of the knee ligaments and meniscus. An MRI scan can provide valuable confirmation of the diagnosis, particularly revealing any tears in the ACL. Furthermore, the MRI may distinguish the type of tear—whether partial, complete, or avulsion from either the tibia or femur—providing essential information for surgical planning. Additionally, the MRI might reveal bruising of the bone resulting from the injury.
Treatment
Non-operative
ACL tears do not naturally heal. Some patients choose to forego reconstructive surgery. Opting for non-operative treatment can heighten the risk of developing arthritis and meniscus tears due to joint instability. Prior to surgery, non-operative measures such as anti-inflammatory medication, physical therapy, cryotherapy, and activity modification may be recommended to alleviate swelling and restore mobility and strength. Studies have shown that surgical intervention typically yields less complexity and superior patient outcomes. However, non-operative treatment may be bypassed for surgical patients if urgent repair of concurrent meniscus and cartilage injuries is necessary.
Operative
The way ACL tears are managed depends on the specific type of tear. If the ACL is torn off from either the femur (thigh bone) or the tibia (shin bone), ACL repair might be recommended. This repair is done through a minimally-invasive arthroscopic procedure where the torn ACL is sewn back into place and secured with screws or buttons. Additionally, a strong suture may be used to reinforce the repair. In cases where a more extensive reconstruction is necessary, a new ACL graft is used to replace the original ligament. The choice of graft placement technique and the type of graft used is a decision made collaboratively between you and your surgeon. Most often, these procedures are also conducted arthroscopically. The graft can be sourced either from tissue around your knee or from a donor. The timeline for postoperative rehabilitation, as well as the return to daily activities and sports, varies based on the specific technique and graft chosen, and is determined by your surgeon's professional judgment.
Reconstruction
Posterior Cruciate Ligament (PCL)
Causes
Symptoms
ACL tears do not naturally heal. Some patients choose to forego reconstructive surgery. Opting for non-operative treatment can heighten the risk of developing arthritis and meniscus tears due to joint instability. Prior to surgery, non-operative measures such as anti-inflammatory medication, physical therapy, cryotherapy, and activity modification may be recommended to alleviate swelling and restore mobility and strength. Studies have shown that surgical intervention typically yields less complexity and superior patient outcomes. However, non-operative treatment may be bypassed for surgical patients if urgent repair of concurrent meniscus and cartilage injuries is necessary.
Diagnosis
Your surgeon will conduct a comprehensive assessment, including a detailed medical history and a physical examination supplemented by X-rays. During the examination, signs such as swelling, restricted motion, and diminished strength may be observed. Your surgeon will perform specific maneuvers to evaluate the integrity of the knee ligaments and the meniscus. Additionally, an MRI scan can be beneficial in confirming the diagnosis, particularly revealing a tear in the posterior cruciate ligament (PCL). This imaging can also specify the nature of the tear—whether it's partial, complete, or involves avulsion from either the tibia or femur—thus aiding in treatment planning. Moreover, the MRI may detect bone bruising resulting from the injury.
Treatment
Non-operative
PCL tears typically do not mend naturally. Yet, certain individuals could resume regular activities based on the tear's type and severity. Non-surgical approaches, such as anti-inflammatory medication, physical therapy, cryotherapy, and modifying activities, might be advised to reduce swelling, restore mobility, and strengthen the knee. A brace could also be suggested for returning to sports. If symptoms persist, like pain or instability, your surgeon may recommend reconstructive surgery.
Operative
The management of PCL tears varies depending on the specific type of tear. If the PCL is torn off from either the femur (thigh bone) or tibia (shin bone), surgical repair may be necessary. This repair is typically conducted using minimally invasive arthroscopic techniques, wherein the torn ligament is reattached and secured in place using screws or buttons. Additionally, high-strength sutures may be used to reinforce the repair. In cases where a more extensive reconstruction is needed, a new PCL graft may be utilized to replace the damaged ligament. The choice of graft type and placement technique is a collaborative decision between the patient and their surgeon. Most procedures for graft placement are minimally invasive and can either use tissue from around the patient's knee or from a donor. Following surgery, rehabilitation, and the timeline for returning to daily activities and sports are determined based on the specific technique used and the type of graft employed, guided by the surgeon's expertise and discretion.