Anterior cruciate ligament surgery

All professional athletes know that an anterior cruciate ligament surgery is vital if they wish to maintain their status at the very top. Unfortunately though, this surgery also signals a lengthy spell on the sidelines to recover and rebuild.

Despite this, there are some people who choose not to go in for anterior cruciate ligament surgery should they suffer the injury. After all, a fully functioning anterior cruciate ligament isn’t essential for everyone. Then there are some athletes who rupture an anterior cruciate ligament and will sometimes - after the knee swelling and pain diminishes - go on to run for several years without even realising that a key knee ligament is missing. Eventually, though, problems usually arise, because the loss of the anterior cruciate ligament leads to a lack of stability in the knee.

After anterior cruciate ligament injuries, doctors sometimes tell patients to 'test their knee out' for a period of time while they're considering the possibility of surgery. Although this can help an athlete figure out exactly the level of their cruciate ligament damage, it can often prove fruitless in most cases and even worsen the severity of the injury.

For the 'high-demand' patient who wants to return to vigorous training, anterior cruciate ligament surgery is the best way to increase the chances of returning to near-normal activity.

However, there's lots of controversy concerning anterior cruciate ligament reconstruction. The first debatable point is how long to wait after the injury has occurred. Many doctors recommend waiting at least three weeks after injury before reconstruction occurs, but a consensus is emerging that the surgical procedure should not take place until good range of motion returns to the knee and the associated quadriceps muscle is strengthened. This seems to lower the risk of developing excessive amounts of fibrous connective ('scar') tissue in the knee after surgery.

Post surgery protocol

The post-surgery recuperative period and anterior cruciate ligament rehabilitation programme can be even more important than the surgery itself. Activities should be arranged to promote healing, upgrade flexibility in the knee, and strengthen surrounding muscles. A passive range of motion programme (stretching) following surgery aids in the healing process, promotes better nutrient flow to the cartilage caps at the ends of the femur and tibia, and prevents excess tightness from developing in the knee. A hinged knee brace which prevents hyperextension or hyperflexion should be used during the four to six weeks after surgery in order to prevent ruptures of the new ACL (stretching activities take place without the brace on, however).

Although maintaining adequate range of motion is the primary focus immediately after anterior cruciate ligament surgery, strengthening is also initiated without great delay. A consensus is emerging that it's best to perform the strengthening work in a 'closed-chain' manner - with the feet (or foot) firmly planted on the ground and the leg in a weight-bearing position. However, stationary bicycling is also utilized to increase leg strength and overall aerobic capacity; the bicycle seat is usually adjusted to keep the knee between 10 and 90 degrees of flexion.

About four to six weeks after anterior cruciate ligament surgery, the patient can progressively begin to carry out one- and two- leg squats as well as forward and backward walking with elastic resistance. Increased-resistance cycling and stair-stepping also help to renew strength in the knee area. At eight to 12 weeks, side-to-side movements are begun in order to strengthen the knee in all directions of motion.

The key point to remember after anterior cruciate ligament surgery is that every effort must be made to increase range of motion and flexibility at the knee. Knee weakness can usually be remedied by extra strengthening exercises, but increased stiffness can sometimes be permanent if not corrected by further surgery.