(Anterior cruciate ligament reconstruction; ACL surgery, ACL reconstruction abroad)
|Benefits||returning to sports, active life, knee stabilization|
|Stay in Poland – Comfort Package||7 days|
|Stay in Poland – Full Rehabilitation Package||14 days|
|Follow up||next day, 3 days, 10 days stitches removal, 6 weeks after surgery, then if needed|
|Back to work time (office)||6 weeks|
|Full recovery time||8-12 weeks with rehabilitation|
|Approximate Package cost||please see in fees section|
1. General Treatment Information
a) Expected results, benefits
What are the benefits of undergoing ACL reconstruction?
Arthroscopic ACL reconstruction is nowadays the most common technique of returning to a knee stability. This method has a variety of advantages compared to open surgery. The precision is very high, it does not require the immobilisation of the knee with plaster, rehabilitation may start just one day after the procedure, scares are subtle, and the hospitalisation is short. In most cases coming back to full fitness activity is possible, this method is widespread to professional sports players (footballers, skiers) and with a good, long and strenuous rehabilitation the effects are great.
b) About the procedure
ACL is one of the most commonly injured knee ligaments, so the procedure is also well known and often performed by knee surgeons, although it is not that simple. ACL reconstruction is a procedure to reconstruct the anterior ligament in the centre of your knee. Broken/injured ligament is replaced by the new one – made from either synthetic material, quadriceps tendon, proper patellar ligament or, the most common – gracilis tendon and semitendinosus. This ligament is essential to keep your knee stable. Anterior cruciate ligament (ACL) keeps your shin bone in place.
c) Treatment Schedule
In ACL reconstruction surgery you will likely receive a general or regional (spine) anaesthesia. The whole procedure will be completely pain – free, but there are two differences: in local anaesthesia, you will get an injection in the space between two vertebrae, and you will be unable to feel anything from the waist down. You will be conscious through the whole procedure though and will be able to watch the surgery on the screen. After this kind of anaesthesia, you will need to stay in horizontal position for a couple of hours.
During reconstruction, you will get a new ligament transplanted into your knee in the place of the old one. This tissue taken from your body (quadriceps tendon, proper patellar ligament or, the most common – gracilis tendon and semitendinosus) is called an autograft, and the tissue from a donor is called an allograft. In most cases the procedure is performed with the arthroscopic method, meaning your knee will be not completely open, but small cuts will be made, and the micro camera and other surgical tools will be inserted into your knee through this cuts. During the surgery, your doctor will fix any other damage to your knee and then replace your old torn ACL with the new one. If an autograft is used than the surgeon will have to make a larger cut, to remove a tendon from the other part of your body. He will have to prepare the ligament shape and strengthen it with stitches, then after making tunnels in your bone the new ligament is brought inside. The autograft will be placed with screws (usually titanium hook called endobutton and bio-soluble screw). At the end of the surgery, every cut will be closed with stitches. You may need a drainage (small pipes) to remove excess fluid from the knee (usually for a couple of hours after surgery).
d) Potential side effects
What are the side effects of undergoing ACL reconstruction?
Although the procedure is considered safe and complications occur infrequently; there is always a small risk that any of following may appear:
- Infection (if you feel fever, chills, increased pain, significant swelling it may be a signal of an infection).
- Blood clots
- Accumulation of blood in the knee
- Injury of a nerve
Also, a general anaesthesia may cause risks like allergic reactions or breathing problems.
e) Full Recovery Time
How long does it take to recovery from ACL reconstruction?
Despite the complexity of the knee ACL reconstruction surgery, most patients (about 80 – 90 % ) get their desirable results. The level of the knee recovery after reconstruction would depend on the state of the knee – if it was the first, or next surgery, the general health condition of the patient, age and commitment to physical rehabilitation. You can divide the phases of recovery into four parts. In the first – early post-surgery (1 month), the phase of getting back to core functions (till 3rd month), the phase where you come back to full joint functionality and recreational activity (3-6 month) and finally the last one – phase of preparation to full sports activity (6-9 month). You need to be conscious that coming back to full sports activity requires a lot of motivation and patience in physical rehabilitation and training.
2. Patient’s preparation
How shall I prepare for ACL reconstruction surgery?
The surgeon will explain to you how to behave before, during and after knee surgery. Before undergoing the ACL reconstruction surgery, you will have to take part in a few weeks long physical therapy to get the full range of motion. It is a key indicator for your doctor to prepare a proper length ligament, so you could bend and straighten your leg fully after the surgery. Probably doctor will ask you to stop smoking – it increases a risk of getting a wound infection, and also may slow down your recovery or even lead to complications. You may be asked to wear compression stocking – they prevent blood clots in your legs. You may receive an anticlotting injection instead. You may be asked to shave your leg before the surgery. If you have a general anaesthesia, you will be asked not to eat or drink anything for about six hours, before your surgery. Vital is to follow the rules to stop taking medicines that rarefy your blood (like aspirin, ibuprofen, naproxen) during two weeks before surgery, not to drink alcohol. If you have any illness like cold or fever, it may also influence your possibility to get the surgery. To plan your procedure properly, your orthopaedic surgeon may arrange some tests like blood counts, electrocardiogram EKG or MRI.
Before making a decision about the ACL reconstruction your doctor will probably make a former careful examination- usually, he will make you some extra tests like blood tests, X-Ray, Ultrasound or MRI scan, to check the evidence of the injury to other knee parts like ligaments articular and meniscus cartilage. Usually, other tests are performed to identify meniscus tears – for instance, the Lachman’s test (Doctor will feel the movement of the tibia to the femur during the movement) or a shift pivot test.
4. Qualification for the procedure
As the ACL reconstruction is a complex surgery with long and strenuous rehabilitation. It is recommended if you are an athlete or a professional sports player wanting to continue training, you are a young and active person, the injury causes your knee to buckle during daily activities, or more than one ligament or cartilage is torn or broken.