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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.