ACL surgery

You may need surgery to replace a broken cross band if you have damaged the front cross band. This is especially true if you are engaged in sports where the load on the knee is great. The new cross band is made by another tendon from your leg.

A cross-band operation is done with arthroscopy, peephole surgery. This means that a doctor will operate the knee joint using an arthroscope. An arthroscope is a thin metal tube that is inserted into the joint through a small hole and transfers images to a monitor, where the doctor can follow the work.

Most people who have injured a cruciate ligament do not need a new cruciate ligament, but usually physiotherapy is enough. A cross-band operation does not replace the need for rehabilitation.

Why do I need surgery?

The anterior and posterior cruciate ligaments in the knee are two ligaments that, together with the lateral ligaments, make the knee firm and the lower leg attaches to the femur. The front cross band cannot be sewn together. They have tried unsuccessfully to replace the cross band with artificial material or to transplant from another person. The new cross band used must be a tendon from one’s own body.

It is primarily one of two tendons used. One is part of the kneecap scene, that is, the latter that runs between the kneecap and the lower leg. The other is one of the tendons on the back of the thigh called the hamstring tendon.

Normal sports injury

Injury to the front cruciate ligament is a relatively common knee injury in sports. The most common reason is that you have twisted your knee sharply during sports where you change direction or speed quickly. Examples of such sports are football, handball and basketball. You can also injure yourself when you go skiing, sometimes with twisting force but also in connection with stretching your knee. In connection with the injury, the meniscus can also be damaged. You may then need to have an arthroscopy to attach a damaged loose meniscus. You will then usually replace the damaged cross band at the same time.

You must train the strength after the surgery

If surgery is involved, it is important that you discuss with your doctor why you need the surgery and what expectations you have for the result. You must be prepared that it will require a lot of in-house training for the knee to function well after surgery. How well-trained you are before the surgery also has a bearing on how quickly you get well. The better strength, balance and coordination you have before the surgery, the faster you will be restored. For most who are operated on, the knee becomes stable so that it is possible to continue with high-level sports.

Stop smoking or stop smoking

The benefits of quitting smoking before surgery are many. The wounds heal faster, blood circulation and fitness improve so that you recover faster after surgery. You should stop smoking altogether, but if you are unable to do so, it is good if you can refrain from smoking before the surgery and even the first weeks afterwards. A stop from smoking for four to eight weeks before and after surgery gives the very best effect. Your doctor can tell you what support you can get if you need help quitting smoking.

Physical therapy is often enough

The function of the front cross strap is to steer the knee joint correctly as the joint moves quickly in different directions. This function is required when the load is extra large, for example when you play elite football and in other so-called contact sports when you have to have complete control of the knee. In everyday life when you exercise easier, such as jogging, you do well without front crossbands. Tennis and skiing are also good for many.

In USA, about a third of all those who have damaged their cross band are operated. For others, training is enough to get your knee sufficiently stable. It is important that you contact a physical therapist and get started on the rehabilitation as soon as possible, regardless of whether your knee will need surgery or not. Thereafter, the result can be evaluated and it becomes easier to judge whether an operation can be involved.

Preparations

The night before an operation, you are usually not allowed to eat, drink, smoke or sniff. You should wash with special soap both in the evening before and on the morning of surgery to avoid infection. You can buy the soap at a pharmacy.

Once you have arrived at the hospital, you usually get to see the doctor who will operate you. The doctor tells you how the operation will go and answers your questions. The doctor does a regular body examination and examines the knee to be treated. You will know what type of anesthesia the treatment requires. It is also common for you to talk to the person responsible for the anesthesia if you are going to be anesthetized and get anesthesia.

After the medical examination, you usually have to change into hospital clothes and lie down in a bed before you drive into the operating department. There you will receive analgesic medication, either in liquid form that you swallow or in the form of a so-called suppository that is inserted into the rectum.

How is the operation going?

Prior to the surgery, you will receive local anesthesia, back anesthesia or anesthesia with antibiotics and antibiotics directly into the bloodstream. You don’t know anything about the operation if you have anesthesia or back anesthesia. But if you get local anesthesia, you can sometimes feel that you are being operated on, without it hurting. You can get sedative if you find it uncomfortable.

The knee is washed with bacteria-killing alcohol solution and wrapped in sterile tissue. The doctor begins by removing the tendon to be transplanted. If it is the kneecap scene, an incision is made on the front of the knee joint. If it is the tendon from the back of the thigh, an incision is made on the inside of the lower leg just below the kneecap from where you access the tendon.

The old cross band is removed

The doctor then makes a small surgical incision on the front of the knee and inserts the arthroscope through the hole. A second cut is made to be able to insert small instruments. The old cross band and any scarring are removed. Then the doctor drills a hole from the front of the lower leg and into the knee joint and another hole from the joint to the femur where the new cross band is to be attached.

The tendon that will become the new cruciate ligament is then inserted into the knee joint through the hole in the lower leg, through the knee and up into the hole in the femur. The new cruciate ligament is screwed into the femur, tightened and fastened in the lower leg with a screw.

The knee joint is then rinsed thoroughly and local anesthetic is injected into the joint. Sometimes a drainage hose is left in the joint to lead the bleeding. After two to three hours it is removed.

After the surgery

After the operation, you will be placed in a special ward for observation. It is for the anesthetic to release and for the doctor to check that you do not start bleeding. You are usually allowed to go home the same day, but should not drive yourself because you may be brought in and tired after the operation.

Before leaving the hospital, talk to the doctor who performed the surgery and a physiotherapist. You will receive a training program and advice on how to do the next few days. Usually you need to change dressings after three to six days when a wound crust is formed and then you can shower with the dressing remaining. Then remove the wet dressing and wash the area with soap and water. Then you put on a new dressing.

You must train strength and mobility afterwards

You can strain the leg immediately after surgery, but the first two to four weeks you need crutches. You practice the mobility again by bending and stretching your knee. It is good if you have some help with daily activities for the first time. When the swelling goes down, usually after a few weeks, you can gradually increase the strain on your knee. If your knee starts to swell, it is usually because you have been training too hard.

Sometimes you may be in pain during this period and may need pain relief or anti-inflammatory drugs.

A physical therapist will help you get started on your rehabilitation. It usually starts four to six days after surgery. During the first period you go to the reception two to three times a week, but as you get better and stronger in the knee joint you can manage more and more exercise on your own.

Usually with sick leave

Most people are on sick leave during the first period. If you have an office job, you can go back after about two weeks. You can get sick leave for up to two months if you have a heavy job, for example if you are a construction worker.

How long the rehabilitation takes is individual and depends on how much you exercise and how old you are. The pace of rehabilitation is controlled by the physiotherapist with whom you are in close contact. For elite athletes, it takes about six to twelve months and for regular athletes six to nine months.

You usually get to visit your doctor once or twice after the surgery. The first time is after about six weeks, when the doctor checks that the mobility has returned. The second time is at the end of the rehabilitation, usually after about nine months. Then you get to discuss with your doctor if and if so how to resume your sport.

Complications

It is rare for you to have complications after a cruciate ligament operation. As with other operations, there is a slight increased risk of blood clots. Therefore, you get syringes with blood thinners before surgery. You can prevent yourself from getting a blood clot by quickly getting on your legs and moving after the surgery.

You can also get an infection, although it is uncommon. Signs that you have an infection may be that, early after surgery, fluid is formed in the wounds, that the knee swells, becomes hot, and the skin around the wounds blushes. At the same time you may get fever, pain and more pain as you move. Then you should always contact the hospital where you have been operated.

If the knee swells and becomes stiff, it may be due to bleeding inside the knee. You should contact your physiotherapist if you are unable to complete the rehabilitation exercises.

Most will be fine

For most, the knee becomes stable after surgery. Some get hurt when they strain, often from the front of the knee. The knee can swell up and feel stiff if you strain too hard. Often these problems decrease over time. You may feel that your knee is unsteady if you have not built up the muscles around enough.

If the cruciate ligament has been replaced with the kneecap, you may feel discomfort when you are on your knees in the first year after the operation.

There is an increased risk of knee arthritis following a cruciate ligament injury, especially if the meniscus is damaged. Therefore, it is important to have strong thigh muscles that protect the knee joint after a knee injury.

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