Sewing extremities of the torn ligament (primary repair) is useless.
Surgery involves replacing the ACL by a graft. Then there is no
"hurry" to do surgery when the rupture of the ACL is the
only injury to the knee.
Four to eight weeks are necessary before surgery: it is essential
to wait for the knee to settle down, for the swelling to subside
and to have full mobility before surgery.
When the lateral collateral ligament is injured, surgery must be
done quickly to repair it first. If the full extension is impossible
because of a meniscus lesion, arthroscopy will be necessary rapidly
to excise or suture the torn meniscus fragment. The reconstruction
of the ACL can be done in the same time or later.
I THE OPERATION
The operation usually takes about 50- 60 minutes; it is carried
out arthroscopically except the first phase: harvest of the graft.
Then after assessment of the lesions, the remnants of the broken
ligament are partly taken away: one of the two bundles of the ACL
is frequently intact. Tibia and femur are prepared for making tunnels
(with jigs) through which the graft will be passed. The graft is
then inserted with appropriate tension and fixed with screws, pins
or endobuttons. (more and photos)
II AFTER SURGERY
After surgery, relief of pain by medicines, icing to decrease swelling
are started and the patient does simple exercises for strengthening
the muscle of the thigh (quadriceps). On the day after, passive
flexion is started by the patient. He can walk with crutches and
take weight through the operated knee but he must keep his quadriceps
contracted +++. Note that I use no bracing after this type of surgery.
Patient commitment and involvement are essential for a good functional
The inpatient stay is usually between 3 and 5 days. For the first
three weeks, the patient will simply continue the exercises started
in the hospital (strengthening of the quadriceps, passive flexion
and walking with the leg kept straight by the quadriceps contraction).
The rehabilitation with a physiotherapist usually only starts after
the first three weeks. MORE
You must keep me informed as you go along of every problem you
may have (lack of extension, stiffness, swelling, pain ...); it
is important to prevent, diagnose and treat possible complications
+++. More than that, it will help you going well if I answer to
your questions as you go along. I recommend you not to wait for
the next appointment if you are worried about something (pain, swelling
or anything else).
III 8 weeks after surgery
The aim is to return to daily living with no pain, no limping,
no swelling and good motion (0 -130°). I then recommend to stop
rehabilitation, and to go swimming (but no breaststroke). Cycling
can be started on the fourth month, jogging on the fifth month.
All these activities must be done progressively and without pain.
IV Five months later
We meet again five months after your operation for a clinical and
radiological examination. You will then finish the process of rehabilitation
during the sixth month to reinforce your muscles and especially
do some proprioceptive exercises to be able to practice your sports
with pivoting and twisting in the seventh or eighth month.
V Risks and complications:
This operation is not free from complications even if it is a fairly
routine and safe operation:
Docteur Jean Etienne Perraudin;
Last updated 1 sept 2012.