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Treatment of anterior cruciate ligament (ACL) tear

Friday, 16 August 2002
Answered by: Mathew Varghese
Consultant Orthopaedic Surgeon and Director
St. Stephens Hospital
Delhi
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Q. I met with a two wheeler accident (while I was in India) and had meniscal tear and ACL tear (of the right knee). The meniscal tear was corrected by an orthoscopic surgery at Chennai. I was told that ONLY after 3 months of the incident, the ACL tear can be reconstructed. I still have difficulty climbing and walking on uneven surfaces. My knee is always warm compared to the rest of the body. I don't have pain when I touch my knees. I was advised physiotherapy (iso metric exercises) after my meniscal correction [to ensure stretching of my hamstring]. I am yet to consult a doctor in USA. Meanwhile, I would like to take some advice from this group. I have a question whether ACL tear needs to be reconstructed (is it a must?) or can I leave it to recover with time? If I undergo ACL reconstruction, what is the recovery period, what is the success rate? If I just leave it, what is that I am losing. In general - how serious should I be about ACL tear and physiotherapy.

A.  An anterior cruciate ligament (ACL) injury may be associated with a medial meniscal injury in the knee. Patients may have persistent symptoms because of a deficient cruciate function even after treatment of the medial meniscal injury. The extent of disability varies from person to person depending on the strength of quadriceps and hamstrings, and the level of activity of the person. In a young active person it is desirable to restore cruciate function. However, this ligament cannot be repaired, it can only be reconstructed. Your knee, as per your description is swollen and warm. Swelling usually indicates there is a collection of fluid in the joint. Warmth usually indicates increased blood supply: a usual feature of inflammation anywhere, in your case because of the injury. This can reduce only with isometric exercises and restricted activity particularly climbing of stairs. However, this cannot continue indefinitely. If your symptoms are persisting despite adequate rest and exercises, the symptoms may be because of the instability in the knee. In such a situation it will be better to have reconstructive surgery for your cruciate ligament. Reconstruction of the cruciate ligament is a major surgical procedure and specialists who are routinely doing this procedure should do it. Arthroscopic surgeons, surgeons involved in sports medicine usually do these procedures. I think you should contact one of them in your city. To answer your specific questions:1. ACL tear does not heal by itself.2. If you undergo ACL reconstruction the recovery period depends on the individuals motivation and exercise regimes adopted. On an average patient is able to do stationary bicycling at two weeks, stair climbing at 4-6 weeks, running at 3 months and if you an athlete possible return to athletic activity in 4-6 months. However, it is safer to delay athletic activity to beyond six months. Some surgeons recommend an orthotic support while participating in games for up to one year.3. If you are symptomatic then you should do something about it.

A.  An anterior cruciate ligament (ACL) injury may be associated with a medial meniscal injury in the knee. Patients may have persistent symptoms because of a deficient cruciate function even after treatment of the medial meniscal injury. The extent of disability varies from person to person depending on the strength of quadriceps and hamstrings, and the level of activity of the person. In a young active person it is desirable to restore cruciate function. However, this ligament cannot be repaired, it can only be reconstructed. Your knee, as per your description is swollen and warm. Swelling usually indicates there is a collection of fluid in the joint. Warmth usually indicates increased blood supply: a usual feature of inflammation anywhere, in your case because of the injury. This can reduce only with isometric exercises and restricted activity particularly climbing of stairs. However, this cannot continue indefinitely. If your symptoms are persisting despite adequate rest and exercises, the symptoms may be because of the instability in the knee. In such a situation it will be better to have reconstructive surgery for your cruciate ligament. Reconstruction of the cruciate ligament is a major surgical procedure and specialists who are routinely doing this procedure should do it. Arthroscopic surgeons, surgeons involved in sports medicine usually do these procedures. I think you should contact one of them in your city. To answer your specific questions:1. ACL tear does not heal by itself.2. If you undergo ACL reconstruction the recovery period depends on the individuals motivation and exercise regimes adopted. On an average patient is able to do stationary bicycling at two weeks, stair climbing at 4-6 weeks, running at 3 months and if you an athlete possible return to athletic activity in 4-6 months. However, it is safer to delay athletic activity to beyond six months. Some surgeons recommend an orthotic support while participating in games for up to one year.3. If you are symptomatic then you should do something about it.

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