India is a cricket loving nation. It is the religion which possesses one’s heart. We have seen many of our favorite players being out of some important matches due to injuries. The first-ever ‘Injury Surveillance Report’ prepared by the Rahul Dravid-led National Cricket Academy states that 262 cricketers (male and female) were at NCA for rehab. It also stated that about 74% of career-threatening ACL (anterior cruciate ligament) injuries occur in first 2 years of return to sports.
The knee is often referred to as the most complex joint in the human body subjected to large forces during sporting activities. These forces are resisted by a number of structures including the five main ‘static’ restraints of the knee: the two cruciate ligaments, the two collateral ligaments and the popliteus tendon. The anterior cruciate ligament (ACL) is arguably the most important and well-known of these five structures.
A direct blow to the knee can injure the ACL. You may be surprised to learn that almost 80% of injuries are caused by non-contact events involving a sudden deceleration or change in direction.
Unfortunately, if you’re female you are 2.5 times more likely to rupture your ACL than if you were male. The most cited reasons for these gender differences are:
Reduced knee and hip bending during landing,
Knock knees (greater genu valgum of the knee)
Increased internal rotation of the thigh bone
High quadriceps activity unbalanced by the hamstrings
The influence of the menstrual cycle
So how do you know if you have torn your ACL?
It never ceases to amaze me how consistent patients are at describing their ACL injury. Most likely they would twisted their knee and felt or heard a pop. The patient is unlikely to be able to continue the activity or even bear weight, and the knee fills up with blood very quickly because the ACL has an abundant blood supply. The patient is pleasantly surprised to find out that X-Rays show no fracture and over the next few weeks the knee feels much better. As the pain settles, walking and even running in a straight line isn’t usually a problem but when attempting to turn or sidestep the knee feels wobbly.
There are numerous special tests to assess the integrity of the ACL. This video https://www.youtube.com/watch?v=MeeGWZU_qXc&t=9s demonstrates the Lachman test in an ACL deficient patient and shows the shinbone sliding forwards excessively on the injured leg. When performing the test the assessor cannot feel the stopping sensation provided by an intact ligament.
Would you routinely go for the surgery?
Well many patients try to skip the surgery because they don’t find much difficulty in their daily activities of walking. Many of them adopt the ‘wait and see’ approach. Many studies have shown that due to the instability of knee caused by ACL, there are chances that the meniscus might be damaged leading to early signs of osteoarthritis of knee joint.
If I agree for surgery, what will happen to my knee?
As the ACL cannot heal on its own, a graft is used to reconstruct and replace your old ACL. Tunnels are drilled in the femur and tibia bone to securely hold your new ACL in place. The type of fixation device that holds the graft in place depends on the type of graft used. This surgery is done under local anesthesia takes about 60-90 minutes.
What is a graft?
A graft is a tissue that is used to replace or substitute for your ACL. Two types of grafts are used: autografts and allografts. Autograft is a graft that comes from your tissue. Allograft is a graft that comes from a donated cadaver graft. The most common autografts are the patellar tendon (BTB), quadriceps tendon, and hamstring tendons. Typically, the bone-patellar tendon-bone (BTB) autograft is used in athletes that play contact sports such as football, hockey, or cricket. The quadriceps tendon autograft is a newer graft with excellent outcomes and less pain compared to the patellar tendon graft. Hamstring grafts are often used in certain patients, such as younger patients who are skeletally immature (meaning their growth plates are open and they are still getting taller).
How long do I have to stay in hospital?
As per the protocol in RNH , your stay will be for 3 to 5 days depending on your level of progress. Your first follow up will be 7 to 10 days post discharge.
When do I start with physiotherapy?
Physiotherapy is started from the next day of surgery with some basic maintenance exercises for the knee. You will be in a brace for 6 to 8 weeks following surgery. This brace protects the graft until your muscles are strong enough to support your leg without buckling or giving out.
We follow the 30 °-60 °-90 °-120 ° program. You can start bending your knee from the very next day of surgery till 30 °. Every week you can progress to further 30 °
You will be using crutches or walker for about four weeks following surgery. Your physiotherapist will help determine when it is safe to discontinue the crutches/walker and start weight bearing on the operated leg.
When can I get back to my routine?
At 3 months post-surgery, you can start running/jogging. Sports-specific training can be started at 4 to 5 months after surgery. You may be able to return to competitive sports depending on your progress and rehabilitation after 9 to 12 months which will reduce the risk of re-injury.
What if I have further queries?
We encourage you to visit us and have a discussion.