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After
evaluating the MRI results, the orthopedic surgeon recommended
surgery to reconstruct the ACL tendon. Derrick was a young
athlete who had dreams of playing professionally, and would need the
full function of his knee. Derrick would definitely not return
to play this season, but if all went well, would return the following
season.
Instructor's
Note: A
conservative, non-surgical approach of treating an ACL tear is also
an option. The patient undergoes extensive physical therapy to
strengthen the knee. Although the knee will not function as
well as it once did, this is often the best approach for an older or
nonathletic patient.
The
surgery would not take place for 3-6 weeks. The swelling in the
knee would need to subside as well as the hemarthrosis for the
surgery to be successful. The presurgery goal would be to
reduce swelling and pain and restore a full range of motion.
Derrick would begin physical therapy as soon as possible. The
goals of the first phase of physical therapy were to minimize
swelling, pain, and
hemorrhage
after surgery; establish and maintain full knee extension; achieve
good quadriceps control; and to begin working on regaining
knee
flexion
and neuromuscular control.*
The
orthopedic surgeon preformed surgery one month after the initial
injury. At this point the swelling and hemarthrosis had
subsided and Derrick's knee was stronger due to physical therapy.
The surgeon explained that he would perform the surgery
arthroscopically.
The surgeon would use a graft from Derrick's patellar
tendon
to replace the torn ACL ligament.
7.
What is an arthroscope?
8.
What are some advantages of arthroscopic surgery?
Instructor's
Note: The
student may wonder why the torn ACL ligament is replaced, and simply
not sutured together. Surgeons have found that attempting to
repair a torn ligament by stitching is ineffective. The
ligaments do not heal or function as they should. Ligaments are
replaced by an autograft (using tendons from the patient's own body),
or an allograft (using donated tendons from another body). A
patellar tendon autograft is the most common repair.
ACL
reconstruction by arthroscopic surgery
9.
Describe the surgical method used to replace a torn ACL.
*
Principles
of Athletic Training, Ninth Edition,
Arnheim and Prentice, pg. 496.
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