Before Surgery

1. What Can Be Done For An ACL Tear?

The initial goals of treatment immediately after injury are to reduce pain and swelling and regain range of motion and strength. Even if surgery is likely, achieving as much knee motion and strength as possible can greatly reduce complications after surgery.

Immediately after the injury

Post injury exercises

Bracing

Immediately After The injury

Immediately after an ACL injury, the so-called R.I.C.E. treatment is recommended.

R.I.C.E. stands for:

• Rest - The individual is advised to rest the knee from weight-bearing activities allowing the swelling to settle.
• Ice - Placing a cold compress or ice pack on the knee is helpful in controlling inflammation as well as helping to reduce pain.
• Compression - Utilizing an ace wrap for compression around the knee is beneficial to control the swelling.
• Elevation - Lying down with the leg elevated higher than the level of the chest is helpful in controlling and reducing swelling.

The physician may request very gradual weight-bearing exercise immediately after the initial ACL injury. Braces used early after the injury are called rehabilitation kneebraces and are off-the-shelf designs used for conservative treatment of the ligament tear. This type of brace is also used for postoperative care of the injured ACL. The rehabilitation brace, also called a post-operative brace, is used immediately post-injury in an effort to put the joint at rest and help protect it, while still allowing appropriate but limited motion. This form of bracing is available in two particular types:

• Straight immobilizer - Made of foam with two metal rods down the side that is secured with Velcro and prevents all motion.
• Hinged brace - Allows range of motion to be set by tightening a screw control.

Post-Injury Exercises

As the swelling in and around the joint decreases and weight-bearing progresses, mild strengthening exercises are started.

Quadriceps sets are one example of strengthening exercises at this stage. With the knee placed at approximately 10 degrees from being straight, along with a small towel roll directly behind the knee, the individual pushes downward into the towel roll for a count of six to 10 seconds. This is repeated 10 times. It should be done several times throughout the day.

Increasing the range of motion of the knee becomes a very important part of the program to avoid joint stiffness and muscle tightness. Sliding the heel of the injured leg towards the buttock until a gentle stretch is felt is also a good exercise. This stretch is held for 10 to 20 seconds and is repeated 10 times, several times a day.

Bracing

Bracing for the anterior cruciate ligament comes in two forms:

• Rehabilitation Brace (described above )
• Functional Brace

Functional or sport braces are available both off-the-shelf and as custom-fit. Physicians prescribe this type of brace to treat the unstable knee in people when surgery is not recommended, as well as to protect the knee in those who have had surgery. Functional braces can be worn as the individual returns to work, training, or competition. But they may be most beneficial for individuals who have some instability and who place low to moderate stress loads upon the knee. It is important to the individual who does have instability of the knee from an ACL tear that functional knee braces will guarantee against instability in activities that require cutting, pivoting, or other quick changes in direction. A well-fitting brace will not restrict normal knee movement. 

2. Surgery

Things to take care before the Surgery:

1. Get your Crutches and keep them
2. Get your knee brace. This is required at the time of surgery
3. CPM (Continuous Passive Motion) Machine
4. Get the "Ice Machine". You need this to reduce your swelling
5. Some one needs you to drive back home
6. Buy light weight shoe
7. Keep your medication before going to surgery (pain killers, Nausea, Constipation, Baby Aspirin, Itch Relief Cream etc)
8. If you need to use the stair-case you need help from others to bear your weight on their shoulders

Before going to the Surgery :

1. Don't think about anything. There will not be any pain on the first day.
2. Carry your knee brace to hospital
3. Keep Cruthches in your car. You need them when you have to walk to your home
4. They will ask you not eat food or drink on the surgery day. Be prepared for this
5. Wear loose clothes, atleast shorts.

Check List

· Before Surgery

___ I know where to go.

___ I know when to go.

___ I have checked with my insurance company.

· Day Before Surgery

___ I confirmed the time of my surgery by calling the surgery center.

___ I gave the surgery center a phone number where I can be reached on the day of the surgery.

___ I stopped drinking liquids and eating food at midnight prior to surgery.

· Surgery Day

___ I am wearing loose clothing.

___ I am totally relaxed about surgery, and I am excited about the prospect of getting better.

· Postoperative Day Number One

___ I will make a postoperative appointment with my physician one to four days after surgery, if I have not already.

___ I am still excited about getting better, and I am relieved that the surgery is over

Surgery Details

You will be in the outpatient surgical facility approximately 90 minutes, but your surgery often only takes about 20 to 60 minutes. It is performed as an arthroscopically assisted procedure. Two to four skin incisions, or "portals," are placed in different areas in the front of the knee, dependent on tissue used. Through one of these portals the arthroscope - a small video camera the size of a pencil - is placed into the knee. With the magnification of the arthroscope, the physician can visualize any damage that has occurred. Through the other portals instruments are placed into the joint to remove, smooth or repair the tissues. All additional damage is corrected. 

Water is infused through the arthroscope throughout the procedure and the tissues around the knee will absorb some of this water. The physician does not use a tourniquet device as here is no significant risk of bleeding. The ACL graft is placed into the knee through the small portals and placed into bone tunnels. The ACL graft will then be fixed with the latest biodegradable screws. These screws are MRI compatible and do not show up on X-rays. The small incisions are closed with absorbable sutures and skin tape so that there are no stitches to remove. An ice machine is often recommended after surgery. Most people go home a few hours after surgery. You will need to use crutches and a brace. At home a CPM (continuous passive motion) machine is used four to six hours a day to assist with motion. 

After surgery, water mixed with small amounts of blood will often leak out of the portals and look like blood on the bandages. The drainage on the bandages is mostly water, which is normal. 

Surgery is not without risks. Common risks include, but are not limited to, possible nerve injury, infection, bleeding, allergic reaction, and very rarely, death.