For surgical intervention, there are several key factors that must be considered. In young children or adolescents with ACL tears, early ACL reconstruction creates a possible risk of growth plate injury, leading to bone growth problems. The surgeon can delay ACL surgery until the child is closer to skeletal maturity or the surgeon may modify the ACL surgery technique to decrease the risk of growth plate injury. Activity level, significant functional instability, and presence of combined injuries (meniscal, additional ligamentous, or cartilage damage) are all further indications for surgical intervention.
The current “gold-standard” for reconstruction of the ACL is to use the patellar tendon graft or Hamstring graft. The patellar tendon graft involves using the central 1/3 of the same knee’s patellar tendon and bone chips on each end to reconstruct the ACL. Tunnels are drilled into the bone above and below the knee to place the ACL graft. The benefits of the bone-tendon-bone graft are that the bone chips heal well to the bony tunnels in the leg bones, lower risk of graft failure, and improved stability.Pitfalls associated with patellar tendon grafts include anterior knee pain, patellar (kneecap) pain, weakness of the quadriceps muscle (front of the thigh), and a low risk of patellar (kneecap) fracture.
The hamstring tendon used for grafting the ACL. is generally done through a smaller incision, has little pain associated with the front of the knee, and generally has faster return of quadriceps strength. Fixation of the hamstring graft has been shown to be equal to or greater than the bone-tendon-bone fixation. The cons with hamstring grafting are weakness of hamstring and inner thigh muscle groups and possible elongation of the graft itself.
After surgery, physical therapy is a crucial part of successful ACL reconstruction, with exercises beginning immediately after the surgery. Much of the success of ACL reconstructive surgery depends on the patient’s dedication to rigorous physical therapy. With new surgical techniques and stronger graft fixation, current physical therapy uses an accelerated course of rehabilitation.The patient’s sense of balance and control of the leg must also be restored through exercises to improve neuromuscular control. This usually takes 4 to 6 months.
For return to sports, it is recommended that the athlete participates in sport specific training to mimic sporting activities in a controlled environment before returning to competitive play. This is recommended to prevent re-injury, as well as to maximize the athlete’s ability to play well, without fear or anxiety regarding the injured knee.
PREVENTION OF INJURIES
Unfortunately, no single exercise can prevent injury to the ACL. The good news is that you can give yourself some protection by developing and Maintaining strength and endurance in your lower extremities. To promote stability in the knee, perform closed-chain exercises (e.g., leg presses, squats, lunges) as part of your strength-training program. Also, do some cross training in your cardiovascular workout with the stairclimber, stationary bike, elliptical cross trainer and the ski machine.
You can also avoid an ACL injury by preparing for your favorite sport in the preseason. Plan for at least four weeks of endurance training before your basketball, tennis, or racquetball league begins. Also: Have fun, but be sensible when playing your sport. Whenever you find that you must stay away from your regular routine for two or three weeks due to travel or illness, ease up for several workouts to give your body time to recondition. Preconditioning work out is of atmost importance.