What is ACL reconstruction surgery, and why is it needed?
Reconstruction surgery for the anterior cruciate ligament – or ACL – replaces a torn ACL using arthroscopic (key hole) surgery. The procedure replaces the ACL itself using a graft known as an autograft which is taken from another part of the patient’s body such as the kneecap tendon or hamstring tendon. ACL reconstruction surgery patients typically have a knee which is not functioning as it should. ACL reconstruction surgery repairs existing damage and prevents the condition of the knee cartilage from worsening. Many sports players require ACL surgery, particularly if they are involved in a sport which places a lot of pressure on the ligament, such as Rugby, basketball or football.
What can I expect from the procedure?
Before a procedure, an ACL reconstruction surgery patient will discuss their anaesthesia method with an anaesthetist. Following the administration of the general or regional anaesthesia, the procedure will begin. It typically takes around 60-90 minutes depending on other injuries which may require attention at the same time. In the case of an arthroscopic surgery, two or three small incisions are made and an autograft is taken from a suitable site which would have been discussed with surgeon. This graft or autograft can then be passed through the tunnels made in the femur and tibia. The graft is then fixed in the bone tunnels with screws or pins until it incorporates in the surrounding bone. Local anaesthetic is then infiltrated in the knee joint and the wound for post-operative pain relief.
ACL reconstruction recovery time
Following reconstruction surgery for an injured or torn ACL, patients are allowed to fully weightbear from very next day. They may need a knee splint for a week or two until quadriceps control returns. Physiotherapy plays an important part in patient’s recovery and there compliance with rehab regimen is crucial. Time to return to work can vary and this will depend on the nature of their job. Jobs which require heavy lifting or long periods of standing can take from 6-12 weeks to return safely. Patients can begin cycling or jogging three months after surgery but contact sports is allowed only after nine months.
What are the symptoms of patello-femoral joint disorder?
Symptoms of patello-femoral joint disorder include chronic knee pain at the front of the knee joint, instability and a restriction of mobility particularly stair climbing.
What are the options for treatments?
There are several surgical options available to address the patella-femoral symptoms after non-surgical treatment with physiotherapy and orthotics have failed to provide adequate pain relief. These include
- Lateral release: This procedure addresses a tight lateral retinaculum, which is the ligament on the kneecap’s outside edge. This helps to improve the patellar tracking.
- Partial lateral patellar facetectomy: An alternative to lateral release which focuses on excising the outer edge of the patella.
Arthroscopic debridement: This procedure focuses on the removal of torn menisci, or smoothing rough articular. It seeks to remove bodies which are capable of interfering with joint motion. This type of surgery benefits from arthroscopic instrumentation, meaning only small incisions are needed.
Patellofemoral realignment:This surgery is capable of treating the instability which can be a symptom of patello-femoral joint disorder. It uses autogenous tissue grafts in the correction with or without bony surgery.
Microfracture: Chondral defects can be treated by this procedure, which involves the removal of unstable cartilage and drilling some holes in the damaged part to try and grow some fibrous cartilage.
Patellofemoral replacement: This is a form of partial knee replacement and an alternative to total knee replacement surgery. It is used only when a patient’s bone or cartilage damage is located on the under surface of the knee cap and the thigh bone groove in which it rests.
The recovery time for patello-femoral joint disorder surgery is entirely dependent on the type of surgical intervention being used and can necessitate the use of walking aids, and/or the taking of medicine to improve pain, as well as physical therapy.
What is a revision knee replacement?
A revision knee replacement is an operation which involves the replacing of previous implants, or in some cases making small adjustments which are vital for maintaining a knee replacement
Why is a revision knee replacement needed?
There are several reasons why a revision knee replacement may be required. The commonest reasons are wear of plastic insert and implant loosening. A revision knee replacement for worn plastic requires a fairly straightforward swapping of this plastic insert. The problem of implants coming loose and osteolysis, which is an erosion of the bone that causes pain and stiffness, can also be rectified by replacing all implants during revision surgery. Other reasons for revision include infection which results in swelling or fever symptoms and instability that makes walking hard for patients.
What does revision knee replacement surgery involve?
The nature of each revision knee replacement is entirely dependent on the type of revision which is required.
The surgeon will use the previous skin incision to expose the knee joint. Usually, revision surgery is more complex and requires specialized instruments and implants. Sometimes bone grafting may be required to replace the lost bone. The surgery can sometimes take up to three to four hours to finish depending on the complexity of the procedure.
Following a revision knee replacement, patients typically stay in hospital for between three to five days, and crutches are usually used for a period of four to six weeks. Following this time, smaller walking aids such as a walking stick are often used for support. Physical therapy is a crucial element of recovery following a revision knee replacement and can be started almost immediately following surgery. Activity level and the intensity of exercises can be ramped up gradually, with a tailored programme for a patient being provided by a physiotherapist. The overall recovery time is longer than a primary knee replacement and residual pain and swelling can take 6-12 months to settle down.
How do I decide if I need surgery?
The decision to proceed with surgery is yours only. It should only be made after discussion with your surgeon and you are satisfied that you have been acquainted of the risks and rewards of the procedure. It is important to keep in mind that your surgeon cannot guarantee that the surgery will meet all your expectations or that the surgery has no risks.
Preparing for your surgery
You may be sent a health questionnaire to fill in and return before your admission. You may also be asked to come in for some tests in advance such as:
- A chest x-ray
- A heart tracing (ECG)
- Blood tests
Please make sure you inform Mr Gulati if you have any other medical issues such as diabetes or any allergies. You will need to bring in a list of all your current medication you are taking especially blood thinners such as warfarin. Furthermore, it is imperative to let us know if you will not have anyone at home to help you after your discharge from hospital.
How long before my surgery should I stop eating and drinking?
If you are having a general anaesthetic, you must eat nothing for 6 hours before your operation. You can have water only up until 3 hours before.
What happens when I arrive at the hospital for my operation?
You will usually be admitted on the day of your operation. A nurse will show you around your room and explain what will happen during your stay. You must remove all jewellery, makeup, nail varnish, contact lenses or glasses, dentures, dental plates and hearing aids. You should lock away any valuables. The nurse will check your blood pressure, pulse and temperature and measure you for support stockings. These are put on just before the operation to reduce the risk of blood clots. Your anaesthetist will discuss the type of anaesthetic and pain relief after the operation. Mr Gulati will discuss the operation with you and once you agree to proceed you will be asked to sign the consent form. Please do not hesitate to ask any questions that you may have about the operation. The Physiotherapist will show you exercises to do and plan your discharge safely.
Will I be in pain after my operation?
It is easier to prevent pain and so you will be given a range of painkillers. These can be increased if needed. Please ask the nurse if you require more pain killers.
Are there complications to having surgery?
All operations have risks irrespective of how minor they are. Detailed information on the risks and benefits of the operations can be found on www.orthoconsent.com Please feel free to ask Mr Gulati if you are unsure of the risks associated with an operation
How soon can I drive/ fly after my operation?
This depends upon the type of surgery. Mr Gulati normally recommends no flying/driving until 6 weeks after an operation. However, each case can be discussed on its individual merits. It is advisable to inform your motor insurance company that you are resuming driving after your operation, once you have been cleared by Mr Gulati.
When will I be discharged from hospital?
Mr Gulati will discuss with you how long you will expect to stay I hospital. It is important for you to make arrangements for a friend or family member to take you home. If you are having day surgery it is recommended that you have a responsible adult with you for the first 24 hours following surgery. If this is not possible then it is advised that you stay in hospital overnight. Upon discharge you will be given medications and painkillers. The physiotherapist will give you information on the exercises you should be doing to aid your recovery.
How to make your home safer following surgery:
- Fix electrical cords so as not to trip on them
- Arrange furniture so it is easy to get around with crutches
- Fasten or remove any rugs that may cause you to slip
- If possible have a responsible adult stay with you for a few days