Global Health Asia-Pacific Issue 2 | 2023 - Page 35

awkward landing resulting in similar forces into your knee after a jump .
In the classic ACL injury , the person may hear a loud “ pop ” sound from the knee followed by pain , swelling and difficulty weight bearing . While most of these symptoms settle if left untreated , with a reduction in the swelling after 2-3 weeks , the patient will still experience instability of the knee . Symptoms of “ instability ” are when the knee feels like it is ‘ giving-way ’ or buckling whilst changing direction during walking or running . Some patients describe this feeling as being unable to ‘ trust ’ the knee . Some also describe a sensation of the knee �locking ’ or �jamming ’ when trying to flex and extend the joint which is usually followed closely with pain and discomfort . Over a longer period of time , the instability may give rise to other problems such as meniscal tears . The menisci are specialized structures in the knee which help with load bearing and distribution of forces . The accelerated wear of the cartilage can manifest as early-onset arthritis .
Management of an ACL injury must be implemented immediately . Measures to reduce pain and swelling are the main goals of early treatment which consists of rest , ice packs , compression and elevation of the limb ( commonly summarized via the mnemonic R . I . C . E ). The gold standard of care requires early presentation to a doctor or medical trained professional to confirm the diagnosis and important associated injuries . Apart from routine history and clinical examination , these days , MRI scans are the main diagnostic tool for confirming AC� and other commonly related injuries ( i . e . cartilage and / or meniscus ). With this information , the orthopaedic surgeon may advise either for conservative ( minor strains / incomplete tears ) or surgical management ( ACL tears with other corresponding injuries ).
In my practice , the patient is counselled thoroughly about the whole process of ACL surgery and emphasis on post-operative recovery . ACL surgery in my hands is performed via minimally invasive arthroscopic instrumentation using a small portion of the patient ’ s hamstring tendons as the replacement graft for their torn Anterior Cruciate Ligament . The operation takes about 60 – 90 minutes depending on the complexity of the case and a knee brace is applied for a period of six weeks . In my ACL protocol , I allow my patients to walk on the operated leg on the day of surgery with the aid of a crutch and most patients are discharged back home within 24 hours .
Post-operative rehabilitation and exercises start immediately after surgery . The patient are educated on the appropriate exercises to do with the help of physiotherapy with clear goals following certain time intervals . In simple terms , the aim is to achieve full range of movement ( first six weeks ) followed by muscle strength ( 3 months ) and in the end , functional return to the patient ’ s pre-injury status ( between 6 – 9 months ). Patients are reviewed at regular intervals in both clinic and physiotherapy to ensure smooth
Anterior cruciate ligament injury
progress post-operatively and to identify problems early should these arise .
Overall , ACL reconstructive surgery is an excellent option following injury with large studies reporting success rates between 86 – 97 %. The patient plays a crucial role and emphasis on complying strictly to post-operative do ’ s and don ’ ts is just as important as the operation to reconstruct the ACL in my opinion . A good patient , having a good operation , done by a good surgeon for good reasons gives a good outcome . Thank you .
Dr Gandhi Nathan Solayar
GlobalHealthAsiaPacific . com ISSUE 2 | 2023