ACL Reconstruction – Post-Treatments

Anterior Cruciate Ligament (ACL) Injury

Diagnosis: MRI research outcomes and accuracy of seeing the ACL injury

An August 2022 study (6) reviewed 18 previously published articles, with arthroscopy, surgical exploration, and MRI as the reference standards for clinical tests in diagnosing ACL injuries. Results suggests that the capability of the four clinical tests to diagnose ACL injuries was high.

Types of ACL injuries

Grade 1 — ACL sprain

Conservative care options for ACL Grade 1 sprain:

Conservative care options for ACL Grade 1 sprain: REST

Conservative care options for ACL Grade 1 sprain: PRICE

Conservative care options for ACL Grade 1 sprain: Physical therapy and exercise

Conservative care options for ACL Grade 1 sprain: Anti-inflammatories

Conservative care options for ACL Grade 1 sprain: Knee braces

Conservative care options for ACL Grade 1 sprain: Regenerative medicine

Conservative care options for ACL Grade 1 sprain: Stem cell therapy

Conservative care options for ACL Grade 1 sprain: Donated cell therapy

Conservative care options for ACL Grade 1 sprain: Platelet Rich Plasma therapy

Conservative care options for ACL Grade 1 sprain: Prolotherapy

Grade 2 — Partial ACL tear 

A January 2023 study examined the impact of ACL injury on walking. (7) Injuries in the anterior cruciate ligament (ACL), including partial tear and lengthening of the ACL, change the dynamic function of the knee. . .This study aimed to investigate the effects of different levels of ACL injuries on knee stability and ACL tensional force to identify the critical injury level.

The results:

  • The average tibial anterior translation increased significantly when the ACL stiffness decreased to 25% of its original stiffness.
  • The average tibial anterior translation increased significantly at an increase in initial length of 10%.
  • The knee with partial ACL tear had a nonlinear decrease in ACL forces owing to the increase in the level of ACL injury, while the knee with ACL lengthening had linear decreased ACL forces.
  • The partial tear of the ACL caused translational instability, while the complete tear caused both rotational and translational instabilities during the musculoskeletal walking simulation. This study presents the effects of partial ACL injuries on joint kinematics and ACL tensional force during the dynamic motion of walking.

Conservative care options for ACL Grade 2 sprain:

Conservative care options for ACL Grade 2 sprain: REST

Conservative care options for ACL Grade 2 sprain: PRICE

Conservative care options for ACL Grade 2 sprain: Physical therapy and exercise

Conservative care options for ACL Grade 2 sprain: Anti-inflammatories

Conservative care options for ACL Grade 2 sprain: Knee braces

Conservative care options for ACL Grade 2 sprain: Regenerative medicine

Conservative care options for ACL Grade 2 sprain: Stem cell therapy

Conservative care options for ACL Grade 2 sprain: Donated cell therapy

Conservative care options for ACL Grade 2 sprain: Platelet Rich Plasma therapy

Conservative care options for ACL Grade 2 sprain: Prolotherapy

Is surgery necessary for a ACL Grade 2 sprain?

Is surgery necessary for a ACL Grade 2 sprain? Research and outcomes

Grade 3 — Complete or near complete rupture/tear of the ACL

A December 2022 study (8) found that in patients over 45 years old, graft choice or drilling technique does not influence outcomes of ACL reconstruction, In this study patients over 45 years old undergoing primary ACL reconstruction without multi-ligamentous injuries were enrolled. Forty-four patients were available at a minimum of two years after surgery date. . . Between femoral tunnel drilling methods, there were no differences in the proportion of patients achieving clinically significant improvement or post-operative outcome scores. While patients who received patellar tendon autografts were more likely to achieve clinically significant improvement in the KOOS sports subscale (pain and function scoring system measured in athletes) there were no other differences in outcomes measures between graft types. Two patients had a retear of their graft, and an additional five patients complained of subjective instability.

Treatments for a complete ACL rupture: Autograft ACL reconstruction surgery

Treatments for a complete ACL rupture: Autograft ACL reconstruction surgery outcomes and complications

Treatments for a complete ACL rupture: Allograft ACL reconstruction surgery

Treatments for a complete ACL rupture: Allograft ACL reconstruction surgery outcomes and complications

Treatments for a complete ACL rupture: Synthetic graft

Treatments for a complete ACL rupture: Synthetic graft reconstruction surgery outcomes and complications

Revision ACL reconstruction surgery

Revision ACL reconstruction surgery causes

Revision ACL reconstruction outcomes

Treatment options for failed Revision ACL reconstruction: Another surgery

Treatment options for failed Revision ACL reconstruction: Conservative care options

Treatment options for failed Revision ACL reconstruction: Physical therapy and exercise

Treatment options for failed Revision ACL reconstruction: Painkillers and Anti-inflammatories

Treatment options for failed Revision ACL reconstruction: Knee braces

Treatment options for failed Revision ACL reconstruction: Regenerative medicine

Treatment options for failed Revision ACL reconstruction: Stem cell therapy

Treatment options for failed Revision ACL reconstruction: Donated cell therapy

Treatment options for failed Revision ACL reconstruction: Platelet Rich Plasma therapy

Treatment options for failed Revision ACL reconstruction: Prolotherapy

The choice of not having ACL surgery 

The choice of not having ACL surgery: Research and outcomes

The choice of not having ACL surgery: Conservative care options

The choice of not having ACL surgery: Physical therapy and exercise

The choice of not having ACL surgery: Painkillers and Anti-inflammatories

The choice of not having ACL surgery: Knee braces

The choice of not having ACL surgery: Cortisone Injections

The choice of not having ACL surgery: Local painkiller injection

The choice of not having ACL surgery: Botox injections

The choice of not having ACL surgery: Regenerative medicine

The choice of not having ACL surgery: Stem cell therapy

The choice of not having ACL surgery: Donated cell therapy

The choice of not having ACL surgery: Platelet Rich Plasma therapy

The choice of not having ACL surgery:  Prolotherapy

Meniscus Ramp Lesion

Meniscal ramp lesion is a tear of the posterior horn of the medial meniscus associated with anterior cruciate ligament (ACL) tear.  A November 2022 paper (5) revealed how difficult it is for an MRI to see this injuries: “A low sensitivity of the MRI in detecting Meniscal ramp lesion  at the Menisco-capsular junction (the meniscus pulls off the bone) was observed, and the reliability of the MRI evaluation for diagnosis of meniscal ramp lesion was not high. Therefore, methodical arthroscopic exploration is essential to diagnose meniscal ramp lesion  even when it is not suspected on pre-operative MRI.”

Peroneal nerve damage

A November 2022 study (9) examined patients with peroneal nerve damage and its relationship to Anterior Cruciate Ligament involvement in multi-ligament knee injuries: There were 221 patients included in this study. The average age was 35.9 years, and 72.9% of the population was male. Overall, the incidence of clinical peroneal nerve injury was 19.5% (43 patients). One hundred percent of the patients with peroneal nerve injury had a posterolateral corner injury. Among patients with peroneal nerve injury, 95.3% had a complete anterior cruciate ligament (ACL) rupture as compared with 4.7% of the patients who presented with an intact ACL. There was 4.4 times of greater relative risk of peroneal nerve injury in the multi-ligament knee injuries with ACL tear group compared with the multi-ligament knee injuries without an ACL tear group. Conclusion: The rate of ACL involvement in patients presenting with a traumatic peroneal nerve palsy is exceptionally high, whereas the chance of having a spared ACL is exceptionally low.

ACL Reconstruction post surgery

Thousands of articles have been written on the various means an athlete can take to help prevent the most devastating of knee injuries – the complete tear of the ACL Anterior Cruciate Ligament. Unfortunately fewer articles have been written for the patient on what to do following an ACL reconstruction with less than hoped for results.

The ACL is the most famous of knee ligaments because of the frequency and the professional and sports notoriety of the injury.

The ACL is a strong connective band deep in the knee that helps prevent hyperextension and provides stability. Interestingly, tears of the ACL occur more without physical contact and instead are linked to the twisting of the knee while the foot remains planted. In a healthy ligament this twisting typically requires a great deal of force to cause a tear, especially a complete tear or rupture in such a strong ligament. The problem is many times the ACL is not a strong as we think it is – it does get weak with overuse.

A portrait of the ACL and the tendon replacement
If you look at a picture of the human anatomy, you will see that muscles are big and red. They are red because of the abundant blood supply that runs through them that helps them grow and repair. Ligaments on the other hand are small and white and resemble thick rubber bands. They are small and white because they do not have an abundant blood supply run through them and because of this, usually do not heal well from injury. This can also hamper the recovery from partial ACL tears. Tendons are equally devoid of a natural blood supply, this is important because many people have a hamstring tendon tunneled and screwed in to the bones to replace the completely ruptured ACL.

Intraarticular hyaluronic acid  injection following ACL reconstruction

A March 2022 paper (1) examined the problems of pain, swelling and joint stiffness following arthroscopic ACL reconstruction (ACLR) surgery that according to the paper ” restrict early return to sports and athletic activities. The patients often receive prolonged analgesic (pain relief) medications to control the inflammatory response and resume the pre-injury activities.” The goal of this study was to evaluate the safety and efficacy of intraarticular hyaluronic acid  injection following ACL reconstruction (ACLR).

The researchers examined post published medical research and identified four studies that would best answer their question on the effectiveness of intraarticular hyaluronic acid  injection following ACL reconstruction (ACLR).

  • There were 182 patients in the intraarticular hyaluronic acid injection group and 121 patients in the control group. In comparison analysis the researchers found: “Although the individual study demonstrated a short-term positive response regarding pain control and swelling reduction, the pooled analysis did not find any clinical benefit of intraarticular hyaluronic acid injection following ACLR surgery.”

Jumping weakness after ACL reconstruction

A May 2022 study (2) suggested that single leg vertical jump performance identifies knee function deficits at return to sport after ACL reconstruction in male athletes. Here is what these researchers wrote: “Vertical jump performance (height) is a more representative metric for knee function than horizontal hop performance (distance) in healthy individuals. It is not known what the biomechanical status of athletes after anterior cruciate ligament (ACL) reconstruction (ACLR) is at the time they are cleared to return to sport or whether vertical performance metrics better evaluate knee function.” Here is what the researchers found: Jump performance, assessed by jump height and Reactive Strength Index, was significantly lower in the involved (ACL reconstructed knee) than the uninvolved limb and controls, with large effect sizes. During vertical jumps, male athletes after ACLR at return to sport still exhibit knee biomechanical deficits, despite symmetry in horizontal functional performance and strength tests. Vertical performance metrics like jump height and Reactive Strength Index can better identify interlimb asymmetries than the more commonly used hop distance and should be included in the testing battery for the return to sport.

A July 2022 study (3) asked if core stability training improved hopping performance and kinetic asymmetries during single-leg landing in anterior cruciate ligament reconstructed patients? The researchers noted that core stabilization is common within rehabilitation, but its influence on hopping performance and single-leg landing kinetics among athletes post-ACLR is unclear. After testing twenty-four male professional athletes who had ACL reconstruction surgery for improvements following an 8-week core stability exercise program. The study findings indicate the positive effect of core exercise on improving and balancing movement in the operated leg compared to the non-operated leg.

ACL and meniscus tear

A July 2022 study (4) suggested that there is a low reoperation rate following lateral meniscus root repair in clinical outcomes at 2 years follow-up in patients who underwent primary ACL reconstruction.

1 Tripathy SK, Varghese P, Behera H, Balagod R, Rao PB, Sahoo AK, Panda A. Intraarticular viscosupplementation following arthroscopic anterior cruciate ligament reconstruction: A systematic review. Journal of Clinical Orthopaedics & Trauma. 2022 May 1;28.
2 Kotsifaki A, Van Rossom S, Whiteley R, Korakakis V, Bahr R, Sideris V, Jonkers I. Single leg vertical jump performance identifies knee function deficits at return to sport after ACL reconstruction in male athletes. British Journal of Sports Medicine. 2022 Feb 7.
3 Fallah Mohammadi M, Dashti Rostami K, Shabanzadeh S, Hosseininejad SE, Ghaffari S, Thomas A. Does core stability training improve hopping performance and kinetic asymmetries during single-leg landing in anterior cruciate ligament reconstructed patients? Res Sports Med. 2022 Jul 21:1-11. doi: 10.1080/15438627.2022.2102919. Epub ahead of print. PMID: 35860900.
4 De Leissègues T, Vieira TD, Fayard JM, Thaunat M. Low reoperation rate following lateral meniscus root repair: clinical outcomes at 2 years follow-up. Knee Surg Sports Traumatol Arthrosc. 2022 Jul 30. doi: 10.1007/s00167-022-07075-3. Epub ahead of print. PMID: 35908114.
5 Yasuma S, Kobayashi M, Kawanishi Y, Fukushima H, Kato J, Takenaga T, Yoshida M, Kuroyanagi G, Nagaya Y, Murakami H, Nozaki M. Diagnosis of medial meniscal ramp lesion is difficult by pre-operative magnetic resonance imaging evaluation and needs a methodical arthroscopic exploration. Journal of Orthopaedic Science. 2022 Nov 1;27(6):1271-7.
6 Huang Z, Liu Z, Fan C, Zou M, Chen J. Value of clinical tests in diagnosing anterior cruciate ligament injuries: A systematic review and meta-analysis. Medicine. 2022 Aug 8;101(31).
7 Koo YJ, Seon JK, Lee G, Koo S. Influences of Partial Anterior Cruciate Ligament Injury on Anterior Cruciate Ligament Tensional Force and Kinematic Stability During Walking. Journal of Biomechanical Engineering. 2022 Aug 19;145(1):011003.
8 Shah NS, Bacevich BM, Boxer RM, Sabbagh RS, Hasselfeld KA, Utz CJ, Branam BR, Colosimo AJ, Grawe BM. Graft choice or drilling technique does not influence outcomes of ACL reconstruction in patients over forty-five. European Journal of Orthopaedic Surgery & Traumatology: Orthopedie Traumatologie. 2021 Oct 15.
9 Markus DH, Mojica ES, Bi A, Kahan JB, Moran J, Mannino BJ, Alaia EF, Jazrawi LM, Medvecky MJ, Alaia MJ. Relationship Between Peroneal Nerve and Anterior Cruciate Ligament Involvement in Multiligamentous Knee Injury: A Multicenter Study. The Journal of the American Academy of Orthopaedic Surgeons. 2022 Nov 15;30(22):e1461-6.

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