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Anterior cruciate ligament (ACL) lesion

We see a lot of ACL lesions and have become experts at treating them without surgery. 

The anterior cruciate ligament is a made up of two bands of fibres lying centrally within the knee joint passing from the front (anterior) to the back (posterior) of the knee. It is attached at its lower end to a little depression in the central part of the upper tibia. This is its anterior attachment. From there it leads upwards and backwards to the inner part of the lateral femoral condyle which forms its posterior attachment. The two bands of fibres are aligned so that one band becomes tight in rather more flexion and the other band becomes tight in more extended positions of the knee. The ACL contributes to control of knee movement so that the joint surfaces of the tibia remain properly aligned to the femur in all stages of knee bend. Without it the tibia becomes unstable in relation to the femur and tends to slide forwards under load disturbing the normal pivoting action of the knee joint. The ACL also contributes to rotational stability of the knee.

Commonly, Anterior Cruciate Ligament injuries result in severe pain, swelling, instability and limited movement of the knee joint, all symptoms which our London Clinic is specialised in treating. 

In cases where sports rehab is insufficient and knee surgery is required, we have excellent relationships with Orthopaedic Surgeons in London who we can refer you to.

Anterior Cruciate Ligament (ACL) reconstruction

Three surgical techniques are used to treat ACL knee injuries:

  • Reconstruction using tendons from semitendinosus (ST) and gracilis (GR) tissues
  • Reconstruction using the patellar tendon
  • Reconstruction using an allograft (donor tendon)
 

Reconstruction with semitendinous, or gracilis tissues are now the most commonly used options. These surgeries involve the use of two medial flexor muscles from the thigh, which are then passed through a bone tunnel into the joint, usually arthroscopically. The time it takes these flexor muscles to heal after surgery is important to consider during the rehabilitation process. 

Reconstruction using the patellar tendon involves the removal of the central third of the patellar tendon through an incision, approximately 5 cm in length. This tendon is then inserted into the joint through a bone tunnel using arthroscopic guidance. This type of intervention tends to weaken the extensor apparatus of the knee which can lead to painful tendinopathy of the quadriceps and patellar tendon if excessive load is used during rehabilitation - therefore increasing the recovery time and making it a less popular option.

Reconstruction with an allograft is a graft obtained from a donor Achilles, or patellar tendon. This intervention has the advantage that tendons are not taken from the patient, avoiding the weakening of the thigh or quadriceps flexor muscles as in the two previous interventions.

Use of a brace to immobilise the knee after surgery is at the discretion of the orthopaedic team. In most cases, the use of crutches is suggested for around 3 weeks. 

Rehabilitation should begin two days after the surgery, either in hospital or at home, before starting at our centre around ten days later. Rehabilitation from these kinds of surgery can take up to five months, with activity alternating between aquatherapy, physiotherapy, and on-field rehab.

Anterior Cruciate Ligament (ACL) rehabilitation

The treatment of the ACL injury can be of two types: conservative and surgical, although the majority of patients decides to undergo a surgical treatment in order to solve problems of instability and early arthrosis resulting from breakage.

The post-surgical treatment includes a first phase of swelling and joint function recovery control (in the first place the extension) and the recovery of the path scheme.

At the same time you can start with the phase of recovery of the strength of the hip dials, buttock of the quadriceps, in a closed kinetic chain and subsequently open (the vast medial is the muscle that atrophies more after surgery, so you must work on his complete recovery) flexors (medial) thigh and knee intrarotatory (who have suffered the biological sample and then weakened). This phase ends with the isokinetic test (the difference in strength between the two arts must be <20% at least).

Exceeded the isokinetic test you can proceed to the last phase, of the recovery of the gestures on the field, but only after doing a metabolic threshold test that shows the status of the patient's health and trained heart rates. Parallel to the work on the field you can work in Green Room. You have to undergo the MAT test that allows you to highlight objectively incorrect motor patterns during codified movements. Only through this kind of test you can complete the healing treatment and work on the prevention of re-injury. The patient is discharged only after all 3 tests and has recovered 100% of the force.

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