= Cae) | Apollo Hospitals towehing Fives Knee injuries, especially amongst sportsmen and older adults, are a common reason why people visit the Knee Centre. Common knee injuries include ACL injuries (ligament), meniscus injuries (cartilage), overuse injuries, and arthritis.Anterior Cruciate Ligament (ACL) Injury of the Knee Joint Knee has 4 ligaments, 2 on each side and 2 inside the joint itself. In any injury one or more ligaments may be injured. The outside ligament has the potentiality to heal by itself if adequate rest has been given to the injured joint, but the inside ligament never heals spontaneously. Once it is injured, it looses function and needs reconstruction. The most injured ligament is MCL (medial collateral ligament) and the next is ACL {anterior cruciate ligament). Inside view of the knee Bf ACL Tear: Treatment i ACL is the inside-front ligament mostly injured in sports. How does someone injure the ACL? a Usually, the patient complains of a sudden injury to the knee and the inability to walk right after the accident. There is often a significant amount of swelling that occurs relatively soon after the injury. In contact sports, such as football, the injury typically occurs when another player impacts the side of the knee. Non-contact ACL injuries also occur, but are mainly in women. In both cases, the player himself may feel a"pop” sound in the knee, What are the symptoms of an ACL [| injury? Initially, the symptoms are pain, and fairly immediate swelling. After the pain and swelling resolve, patients complain of episodes of instability, or giving-way. The knee feels loose.§§ What happens after the ACLinjury? J It depends on the severity of the injury and whether there are any other associated injuries, such as a medial collateral ligament tear ora meniscal tear, Often, the swelling resolves after a couple of weeks. Some patients will be able to function without any problems after they get over the initial injury, especially if they had only a partial tear. The majority, however, will notice "instability" — the feeling that their lower leg is shifting forward on their thigh bone. For some, this will be a minor complain; for others, it will be a significant disability. {| How do you and your doctor decide | if you need surgery? This is a very complicated question and generally can only be answered by discussion with your orthopaedic surgeon. There are a few guidelines, however. Typically, the decision to reconstruct the ACL is based on the following:1. Patient's age and activity level. 2. Associated injuries, such as a meniscal tear, medial collateral ligament injury, or significant cartilage injury. 3. Response to rehabilitation. 4, Amount of instability and magnitude of the patient's symptoms. Generally speaking, a young high football player who injures his ACL and wants to continue to compete at thesame or higher level will require a reconstruction. But other than professional players, patients who have significant instability and do not respond well with medication and therapy also need surgery. If surgery is not necessary, then strengthening exercises, particularly of the hamstrings and quadriceps are prescribed. Non-operative exercise therapy for ACL tears include: + Maintaining range of motion. + Regaining stability by improving your muscle strength. By strengthening the muscles you can compensate for the absence of the ligament. But if you visit just after your injury you need to control your pain first. This should be done regardless of whether you plan to have surgery or not. Because of the swelling (caused by blood in the knee}, the knee will be difficult to extend (make straight) for several days. Cryotherapy is an important aide in relieving pain and decreasing the swelling. You can use an ice-bag if you wish, along with pain killer. Second, get your motion back! It is imperative to get the motion in your knee back as quickly as possible (after resting for a few days) to prevent a permanent loss of motion ("contracture"). This is achieved with various exercises. It is great if you have access to a gym or physical therapy. If not, then do home bound exercises as prescribed by your doctor. Important note: Even if you plan to have the ACL reconstructed, most orthopaedic surgeons will not reconstruct your knee until you have regained your motion. The reason is simple - if you start off with a stiff knee before surgery, you will end up with a stiff knee after surgery.§ ACL Surgery i The Anterior Cruciate Ligament (ACL) is a ligarnent that connects the tibia (shin bone) to the femur (thigh bone). It serves to prevent the tibia (leg) from moving forward relative to the femur (thigh). Arthroscopic view of the knee joint The ACL is in the centre of the knee - it crosses the PCL (posterior cruciate ligament) - hence the name "cruciate". Because the ACL has little to no capacity to heal itself, the ligament can only be reconstructed (replaced) - it cannot be repaired (sewn back together). There are many methods of reconstructing the ligament - be sure to talk these over with your surgeon. Typically, a tendon from somewhere else in your knee or from a tissue bank (allograft) will be used to substitute for your old ACL. There are several choices for grafts including the patellar tendon, hamstring tendons, quadriceps tendon, achilles tendon, anterior tibilias tendon, and others. This tendon is fixed with a variety of methods including screws (either metal or plastic), buttons, pins, etc, The exact type of reconstruction will depend on your surgeon's preference based on his/her experience and success rates. Most surgeons now-a-days will perform this reconstruction arthroscopically. After surgery, there are several steps to your healing: + First, you need ta get your pain under control and decrease the swelling. + Second, you need to rehabilitate your knee. You need to regain your mation, then your strength. This is usually done with the assistance of a physical therapist. However, in our experience, those people who perform exercises on their own, in addition to the 1-3 times a week prescribed physical therapy, will have superior results fram their reconstruction. + Third, braching: we follow brace free protocol- so there is no need of costly knee braces after operation.The second period is the rehabilitation phase. After your ligament has healed, your motion has been regained, and much of your strength improved, your surgeon may recommend various kinds of exercises and crutches for the further rehabilitation of the knee. Your operation is usually done in the same day of your hospital admission. After operation you may feel some pain, and painkillers will be given in adequate amounts. Even then if you have some more pain, talk to your nurse and she will take necessary action. You will be discharged from the clinic typically after two days and the operating surgeon will inform you about the following details: + Walking crutch walking, load bearing, etc. You must use crutches for 2/3 weeks, but your doctor will inform you about the amount of weight you can bear. * Medication Antibiotic to control infection and painkillers are usually prescribed for the 1st week of treatment. When you come back after seven days all the stitches will be removed and physiotherapy and medication will be prescribed. + Physiotherapy Leg rising, a type of static quadriceps exercise, is usually given during the ist week of operation. After 1 week, static quadriceps and range of motion (ROM) exercise will be started with a hope that the ROM will regain fully after 7-10 days, and that is what usually happens. Then from 3rd week onwards, gradually increasing resistive quadriceps and hamstring building exercises will be given to the patient with a monthly check up. We do not use any brace or institutional physiotherapy; rather, we teach the patients to do their exercise at home and by themselves, No special instrument is necessary like cycle, theraband, knee brace, etc, <~ Ph Apollo Hospitals DHAKA— touching lives | Plot: 81, Block: E, Bashundhara Ry’, Dhaka-1229 | | Appointment: (02}-8845242 || Emergency Hotline: 10678 | | Info@apollodhaka.com | www-.apollodhaka.com |