The Lachman Test

     The Lachman test is an orthopedic test used for examining the anterior cruciate ligament.

    - the knee is flexed at 30 degrees

    - examiner pulls on the tibia to assess the amount of anterior motion of the tibia in comparison to the femur

    - an ACL-deficient knee will demonstrate increased forward translation of the tibia at the conclusion of the movement.

     To do this, lay the patient supine on an examination table. Put the patient's knee in about 20-30 degrees flexion,the examiner should place one hand behind the tibia and the other on the patient's thigh. It is important that the examiner's thumb be on the tibial tuberosity. On pulling anteriorly on the tibia, an intact ACL should prevent forward translational movement of the tibia on the femur. 

     This test can be done in an on-the-field evaluation in an acute injury setting, or in a clinical setting when a patient presents with knee pain. In either situation, ruling out fracture is important in the evaluation process. Also when evaluating the integrity of the ACL, it is important to test the integrity of the MCL, because this is a common ligament torn in an ACL injury as well.

On the day of your surgery

On the day of your surgery

• You will asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take your drugs with a small sip of water.
• Your doctor  will tell you when to arrive at the hospital.

After the Procedure

- you will probably go home the day of your surgery and wear a knee brace for the first 1 to 4 weeks. You also may need crutches for 1 to 4 weeks. Most people are allowed to move their knee right after surgery to help prevent stiffness. You may need medicine to manage your pain.

- but some doctor not provide you the medicine because they want  you to be in the naturally process.

- physical therapy can help many people regain motion and strength in their knee. Therapy can last 2 to 6 months.

- how soon you return to work will depend on the kind of work you do. It can be anywhere from a few days to a few months. A full return to activities and sports usually takes 4 to 6 months.

Outlook 

ACL reconstruction is usually very successful. Now, improvements in the surgery and in rehabilitation provide much better results. These improvements include less pain and stiffness, fewer complications with the surgery itself, and faster recovery time. Most people will have a stable knee that does not give way after ACL reconstruction.

how to prepare before a surgery

These surgeries put immense financial, emotional and psychological burden not only on the patient but on the family as well.

It is scary when you do not know what to expect. But with a sense of preparedness and peace of mind, the chance of a successful outcome increases.

Of course, your doctor will give you some tips before your surgery and you need to follow those religiously. But here are a few more tips that you should consider such as:

• Learn about the surgery: ask your doctor or surgeon any questions and concerns you may have before, during, and after your hospital experience. Surf the internet to get the knowledge about the operation
• Seek a second opinion: seek a second opinion from another well-respected surgeon. You can even talk to other people who have had a similar surgery procedure.
• Keep your doctor informed:  do the medical check up or tell your doctor about your medical conditions.
• Plan ahead: Make appointments and schedule all of the preliminary tests recommended by your doctor. 
• Be the best of your health: Eat a nutritious diet, get regular exercise and get enough sleep. 
• Stop smoking: Smoking increases the risk of serious complications with any surgery. It raises blood pressure, makes the heart beat faster, narrows the coronary arteries and smaller blood vessels, and makes more mucus in the lungs. So you must stop smoking at whatever cost. It's best to try to stop at least two weeks before surgery.
• Limit alcohol intake: Tell your doctor about how much and how often you drink. Alcohol can cause excessive bleeding and liver damage, and have unpredictable effects on anesthesia. Stop drinking or limit your alcohol intake to reduce your risk of postsurgical complications.
• Check with your health insurance provider: Your health insurance policy may require you to get pre-authorization. The hospital may take care of this for you, but you want to make sure that all the insurance requirements are met before surgery.
• Pack the items you would be requiring at the hospital: If it is a more than 2-3 day procedure, you may require the following items: Insurance card, additional clothes, slippers, tissues, toothpaste, shampoo and grooming items. Pack them in a bag so that on the day of surgery, you don't have to run around. Do not carry any jewelry or other expensive items.
• Plan your rehabilitation: Rehabilitation process is necessary for better health. Don't view the recovery period as time lost, but rather as time to recuperate and rest. Plan ahead what you would be doing in that period.
• Arrange for help: Arrange for someone to be with you, to take you to the hospital and take you back home and especially be there for the first week after you go home from the hospital.
• Prefer liquids on the night before surgery: You should stop eating any solid foods after midnight before your surgery. Clear liquids can usually be continued, but it is better to follow your doctor's instructions about when to stop eating or drinking before your surgery.
• Pray: And finally, don't forget to pray before the surgery. Not just for you but also for your surgical team and your family.

It is very easy to prepare oneself for any major procedure or surgery especially when one is informed.

ACL reconstruction - cause of injury

cause of injury

Anterior cruciate ligament (ACL) injuries may occur from coming to a quick stop with a directional change while running, pivoting, landing, or overextending the joint in either direction.

ACL reconstruction - degrees

ACL degrees

An injury to the anterior cruciate ligament (ACL) may be described as a partial tear, complete tear or an avulsion (tearing away) from the bone attachments that form the knee.

ACL reconstruction - arthroscopy

Arthroscopy

Arthroscopy allows for the visualization of the interior of a joint through the use of optic instruments. Surgery can now be performed on larger joints using direct visualization and miniaturized techniques. After this procedure, the person can often go home the same day.

ACL reconstruction - aftercare

aftercare

At the end of the surgery, the incisions are closed, and a dressing is applied. ACL reconstruction is usually a very successful surgery. The majority of patients will have a stable knee that does not give way after ACL reconstruction.

ACL reconstruction - procedure 02

Procedure

The old ligament is removed using a shaver or other instruments. Bone tunnels are made to place the new ligament (patellar graft) in the knee at the site of the old ACL. Screws are commonly used to secure the graft in the bone tunnels, although other methods of fixation are used depending on the type of graft used.

ACL reconstruction - procedure 01

procedure:

ACL reconstruction is surgery to replace the torn ACL ligament. There are several choices of tissue to use for the new ligament, including an autograft (tissue from the patient' s own body) or an allograft (tissue from a cadaver). One of the most common autografts use part of the patellar tendon (the tendon in the front of the knee).

ACL reconstruction - indications

Indications

If the ACL is torn, the knee joint may become unstable and affect the ability to perform work or athletic activities.

ACL reconstruction - knee ligament

Normal knee ligament

The anterior cruciate ligament (ACL) is a ligament in the center of the knee that prevents the shin bone (tibia) from moving forward on the thigh bone (femur).

ACL reconstruction - injury

ACL injury

Injury to the anterior cruciate ligament (ACL) is very common and usually the result of a twisting of the leg while applying full downward pressure.

ACL reconstruction - normal knee anatomy

Normal knee anatomy:

The ligaments which attach the upper leg bone (femur) to the large lower leg bone (tibia) create a hinge joint called the knee. The anterior and posterior cruciate ligaments are 2 short, strong ligaments which criss-cross each other in the middle of the joint.

ACL reconstruction - Information

Information

Others names

Cruciate ligament injury - anterior; ACL injury; Knee ligament injury 

Definition 

An anterior cruciate ligament injury is the over-stretching or tearing of the anterior cruciate ligament (ACL) in the knee. A tear may be partial or complete.

Considerations:

The knee is similar to a hinge joint, located where the end of the thigh bone (femur) meets the top of the shin bone (tibia). Four main ligaments connect these two bones:

·         Medial collateral ligament (MCL) -- runs along the inner part (side) of the knee and prevents the knee from bending inward.

·         Lateral collateral ligament (LCL) -- runs along the outer part (side) of the knee and prevents the knee from bending outward.

·         Anterior cruciate ligament (ACL) -- lies in the middle of the knee. It prevents the tibia from sliding out in front of the femur, and provides rotational stability to the knee.

·         Posterior cruciate ligament (PCL) -- works with the ACL. It prevents the tibia from sliding backwards under the femur.

The ACL and PCL cross each other inside the knee, forming an "X." This is why they are called the “cruciate” (cross-like) ligaments.

ACL injuries often occur with other injuries. The classic example is when the ACL is torn at the same time as both the MCL and medial meniscus (one of the shock-absorbing cartilages in the knee). This type of injury often occurs in football players and skiers.

Women are more likely to have an ACL tear than men. The cause for this is not completely understood, but it may be due to differences in anatomy and muscle function.

Adults usually tear their ACL in the middle of the ligament or pull the ligament off the femur bone. These injuries do not heal by themselves. Children are more likely to pull off their ACL with a piece of bone still attached. These injuries may heal on their own, or they may require an operation to fix the bone.

When your doctor suspects an ACL tear, an MRI may help confirm the diagnosis. This test may also help evaluate other knee injuries, such as to the other ligaments or cartilage.

Some people are able to live and function normally with a torn ACL. However, most people complain that their knee is unstable and may "give out" with physical activity. Unrepaired ACL tears may also lead to early arthritis in the affected knee.

Causes:

ACL tears may be due to contact or non-contact injuries. A blow to the side of the knee, which can occur during a football tackle, may result in an ACL tear.

Coming to a quick stop, combined with a direction change while running, pivoting, landing from a jump, or overextending the knee joint (called hyperextended knee), also can cause injury to the ACL.

Basketball, football, soccer, and skiing are common causes of ACL tears.

ACL reconstruction - prevention

Prevention

Prevention:

Use proper techniques when playing sports or exercising. Several women's college sports programs have reduced ACL tears through a training program that teaches athletes how to minimize the stress they place on their ACL.

Although the issue is controversial, the use of knee braces during aggressive athletic activity (such as football) has not been shown to decrease the incidence of knee injuries and may give the player a false sense of security

ACL reconstruction - symptoms

Symptom

Another Names

Cruciate ligament injury - anterior; ACL injury; knee ligament injury 

Symptoms:

Early symptoms:

·         A "popping" sound at the time of injury

·    knee swelling within 6 hours of injury

·         Pain, especially when you try to put weight on the injured leg

Those who have only a mild injury may notice that the knee feels unstable or seems to "give way" when using it.

Treatment

First Aid:

An ACL injury should be treated with:

·         Elevating the joint (above the level of the heart)

·         Ice

·         Pain relievers such as nonsteroidal anti-inflammatory drugs (like ibuprofen)