COMMON QUESTIONS ASKED
What will my knee be like? and What percentage of normal will it be?
There is not a precise answer to these questions. The idea is complete 100% function, but our goal would be to achieve at least 85-95% of normal value, assuming no complications, good motivation, and adequate rehabilitation. It must be remembered that if you could tear your normal ligament, you could certainly tear the replacement. However, our experience has shown that this occurrence is rare. In fact, there is a greater likelihood that you will tear your other knee’s ACL before you tear the reconstruction.
Complications of the surgery are rare, but they can and do occur. Loss of motion is the most common complication which can occur. After the surgery, stiffness, swelling, and scarring can occur around the kneecap and cause difficulty with the rehabilitation. A strict adherence to the rehab protocol can help diminish this occurrence. If this does occur, its worst form is called arthrofibrosis (meaning scarred joints); there can be severe loss of motion and pain out of proportion to known causes. This could lead to permanent loss of motion. This occurrence is rare, and difficult to treat. Mild forms are not uncommon but respond well to vigorous rehabilitation.
The exact cause of this complication is not known. Appropriate timing of the surgery may also diminish the incidence of post operative stiffness and pain making it easier to comply with the rehab protocol. Studies have demonstrated that the surgery should be delayed in the acute phase for at least 3 weeks or until the pain has subsided and full, painless range of motion of the knee has been regained.
Other complications include failure of the operation, either through stretching of the graft over time or by another injury to the knee. Infection can occur and is a serious and difficult complication usually requiring further surgery. Phlebitis or blood clots in the leg and thigh can occur, and is also a very serious complication and could potentially be life threatening.
Rupture or breakage of the patella ligament from the graft harvest site and fracture of the kneecap have also been reported. All of these complications are unusual and do not pose an unreasonable risk in young, healthy people. An extremely rare complication following injury and/or surgery on the extremities is a condition called reflex sympathetic dystrophy.
It is an abnormal response to injury and/or surgery involving the small nerves (sympathetic nerves) that supply the blood vessels and sweat glands. It is extremely painful, and symptoms can involve the entire limb. These symptoms include hypersensitivity, increased sweating, skin color change, and others. It can usually be successfully treated, but the process can be long and frustrating for both the patient and the physician.
Nerve and blood vessel injuries have been reported but are quite rare. Nerve injuries can occur as a result of the surgery or secondary to pressure from the tourniquet. If nerve function does not return, there will be serious dysfunction and disability to the leg. Blood vessel injuries can occur for the same reason, and in the worst case example, could lead to loss of limb.
It should be remembered that these serious complications are extremely rare. Sensory nerves which supply sensation (feeling) to the front of the knee are often cut when the graft is harvested resulting in some numbness in this area. This usually does not cause disability, and the perception of the numbness will usually diminish with time.
Other types of reconstructions (for example, the hamstrings), use autografts obtained from the different location in the body, that are routed in the same or different ways than described above. Still other procedures attempt to tighten the structures on the outside of the knee. However, this “outside” repair alone does not restore normal anatomy and is probably not strong enough to last.
Occasionally, there can be a combination of the inside and outside procedures to repair a severely unstable knee. This injury in young patients who still have open growth plates in their legs requires a slightly different procedure to avoid drilling tunnels through their grown centers.
The autograft would be obtained from the hamstrings and substituted for the torn ACL in a similar fashion as to that of an adult. The post operative rehab is approximately the same. Secondary to recurrent injuries, it is extremely important to stabilize the knee in this group of patients.
Occasionally, an MRI (Magnetic Resonance Imaging) will be recommended prior to surgery to further delineate an injury to the cartilage or ligament. The MRI scanner is composed of a large electromagnet with computerized recording devises and is used to study many areas of the body including the knee. It is a painless test but does require the patient to lie still for approximately 30-45 minutes at a time.
Many factors are considered prior to recommending an MRI versus arthroscopy. The MRI scan is the best non-invasive test available. However, there are limitations to the accuracy of this procedure. While MRI scans are reported to be over 90% accurate, arthroscopy approaches 100% accuracy for the diagnoses of meniscal, ligament, and ACL injuries.
Generally, it is obvious that someone has a torn ACL and desires to have the ligament reconstruction, an MRI would be an unnecessary step and expense. However, if your circumstance indicates that you would benefit from an MRI, then this can easily be arranged. If an MRI is obtained, a return office visit would be required to discuss the results.
*The information contained here is intended to help you and your families/caretakers better understand a particular diagnosis and/or the treatment options available. If you have any questions after reading this, please don’t hesitate to contact Dr. Longobardi’s office at 201.343.1717 for a further explanation.
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