Anterior Cruciate Ligament Injury, Surgical Considerations
The anterior cruciate ligament, or ACL, is one of the major ligaments of the knee that is located in the middle of the knee and runs from the femur (thigh bone) to the tibia (shin bone). When this ligament tears, it does not heal by itself and often leads to the feeling of instability in the knee. Therefore ACL reconstruction surgery becomes necessary. In some people, a second surgery, ACL revision surgery which involves placement of new graft may be needed when ACL reconstruction failure occurs.
The anterior cruciate ligament (ACL) prevents the femur from sliding backwards on the tibia or the tibia from sliding out in front of the femur. It is the major stabilizing ligament of the knee. Together with posterior cruciate ligament (PCL) it provides rotational stability to the knee.
History of Injury
ACL injury is sports related that occur when the knee is forcefully twisted or hyperextended. An ACL tear usually occurs with a rapid directional change with the foot fixed on the ground or when a deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also cause injury to the ACL.
When you injure your ACL, you might hear a “popping” sound and you may feel as though the knee has given out. Within the first two hours after injury, your knee will swell and you may have a buckling sensation in the knee during twisting movements. You may feel instability in the knee, particularly when trying to change direction of the knee.
Diagnosis of an ACL tear is made by knowing your symptoms, medical history, performing a physical examination of the knee, and performing other diagnostic tests such as X-rays, MRI scans, stress tests of the ligament, and arthroscopy.
Initial treatment consists of rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling. Physical therapy may be recommended to improve knee motion and strength. A knee brace may be needed to help immobilize your knee.
Indications for surgery
- Improper placement of drill holes
- Failure of fixation of the graft
- Graft impingement
- Intrinsic graft failure
- Arthrofibrosis (formation of scar tissue)
Before ACL revision surgery, the cause for failure must be identified through history, physical examination, and radiologic evaluation, including X-rays and, occasionally, magnetic resonance imaging (MRI) and computed tomography (CT). An ACL revision surgery needs more than one surgery. During the first surgery, the old screws are removed from the original holes that were drilled to attach the ligaments. Next any further damage is repaired and the tunnels are grafted with donor bone plugs. The second surgery is performed after healing of the bone grafts occur, during which the new holes are drilled and the actual ACL reconstruction is performed.
Following an ACL revision surgery, physical rehabilitation is similar to the initial ACL reconstruction, but may be lengthier and less aggressive. The results are less predictable than the initial surgery and it is very important to protect the reconstructed knee to allow it to heal.
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Houston Knee Specialists
Advanced Orthopedics and sports medicine has numerous Board Certified/Eligible physicians who are thoroughly educated in the latest treatment techniques both surgical and conservative. They are well versed in advances in knee treatments including meniscal transplants, total knee replacements, minimally invasive unicompartmental and total knee replacements
Drs Elbaz and Brooks now perform Platelet-Rich Plasma (PRP) injections for the treatment of patellar tendonitis, quadriceps muscle injury, bursitis, ligament sprain/tear, hamstring tendonitis or tears. PRP stimulates a more rapid healing of tendon, ligament, muscle and bone.
Contact us today to Schedule an Appointment or call us at 281-955-2650 to learn more about our Knee Treatment options.
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What Our Patients Are Saying
Each procedure done by Dr. Patel has been an improvement. Very pleased.
Dr. Patel has been a great Doctor for me. When I was referred to after discussion we decided to do injections in my back. The first two did not work so did two more in a different section of my back. These injections worked great. I’m now able to sleep at night and the numbness in my foot is almost gone. The tingling in my foot & leg is gone and I am very happy about that. I am extremely happy that Dr. Patel is my Doctor. She has been a good listener when I tell her where I hurt and talks to me about what she feels should be done. The final decision is always mine.
On Nov. 22, 2017, I had a spinal injection in my lower back and it was an instant miracle in my life! For the first time in 4 intolerable months of pain, I was finally pain free, and I am now getting a second chance to live again! I am so grateful to Dr. Patel for my new life, and to God for guiding me to her! Thank you so very much Dr. Patel – you are God’s gift to me, thank you for being so awesome at what you do.
Dr. Patel is one of the best Doctors I have ever had. She is pretty good at her job. She makes it plain and simple. She is also very thoughtful. I was very glad to have met her. In other words she is pretty good.
The surgery done by Dr. S. Patel (Actually injections) & the mild medications she has prescribed has surely made my lower back -hip-leg less painful. I have complete confidence in her medical judgement & advice. She will administer second injection in June.
Dr. Patel is a very good Pain Management Doctor. She is one of my favorite doctors.
Dr. Patel has been great at my pain relief. She doesn’t force me to take any meds I don’t want, or injections. She will give me the injection I want when I need it. Great friendly Doctor.
Thank you for the opportunity to express how pleased I am with the excellent care of Stacy A. Bacon, M.D. I have confidence in her ability to care for me as she successfully partially replaced a broken hip 10 years ago, 2007. I also want to compliment Cheryl who set up the appointment. She represents Advanced Orthopaedics & Sports Medicine very well.
It’s been over 8 years since Dr. Bacon replaced by right ankle. I still can’t thank her enough for the years of pain free walking I have done since! And I’m still going strong! I had numerous breaks in my ankle due an auto accident, repaired/set by a different doctor, after multiple surgery’s, I was still limping, in great pain every day. Then I found Dr. Bacon, now, no more pain, NONE, and no more limping after this ankle replacement. I rave about her constantly and would recommend her to anyone who has a foot or ankle issue
I had been in so much pain with my back for years. It got so bad that I knew I had to do something. I went to Dr Mohr for help. I was so afraid to have spine surgery as I had heard so many horror stories. He and his staff were very informative. I was amazed at the new technology in spinal surgery. December 8, 2016 I had rods and pins put in my back. I am so happy I did now. I am healing really fast and the pain is going away as my body heals. Thank you Dr Mohr for you expertise and sensitive nature. You were understanding about my fear and helped assure me so I could receive the help I needed. You are an excellent Doctor.