Case analysis #6: Carmen’s ACL reconstruction

Carmen's story

Carmen is a young, 26 years old football player. She had her first injury several months ago. She came to Nordorthopaedics for meniscus surgery, however, afterwards, she tore her ACL, which was previously partially torn, so this time she needed full ACL reconstruction surgery.

Carmen's diagnosis

ACL is a key structure in the knee as its main function is to keep the knee stable preventing it from sliding backwards and rotating inwards. Carmen was diagnosed with ACL rupture in her right knee after trauma. A partial rupture occurred during the first injury and a complete ACL rupture happened after the second injury.

After the second injury, Carmen was also suffering from knee instability, limited range of motion and discomfort while moving.

A slightly torn ACL is likely to heal and regenerate over time, especially after doing physical therapy. Unfortunately, if it is fully ripped it might need to be replaced, particularly if a patient is young and actively participating in sports.

Performing the surgery

ACL reconstruction surgery typically lasts from 1 to 2 hours and is performed arthroscopically, meaning that only a few incisions are made for the insertion of an arthroscope and other surgical instruments.

Arthroscopic surgery is performed initially to inspect the inside of your knee, and repair or remove any areas of damaged cartilage (meniscus). The new ligament is formed using tissue taken from the hamstring tendons on the inside of the thigh, which can be taken through a small incision on the inside of the knee. Bone tunnels are made through keyhole incisions, and the new ligament is secured to the bone with screws or very strong stitches attached to a device called an endo-button. The skin is stitched together again with dissolving stitches.

What happens after ACL reconstruction?

Carmen was discharged the next day after surgery. Depending on the patient’s condition and the level of knee swelling, the rehabilitation usually begins the same day with light exercises and walking with a brace. Carmen chose to have a few days of initial rehabilitation at our outpatient clinic here in Lithuania, led by a specialist in sports physiotherapy, Dr Laimonas Siupsinskas.

It is a long-lasting rehabilitation that should begin in the first-day post-surgery, starting with the isometric exercises for quads, standing heel raises and gentle stretches for knee extension. Crutches are not necessary if the patient is in good health, however, the knee brace is very important. First, the patient’s leg is kept full extension and every week the angle of flexion should be increased until the patient’s leg is in a natural position and ready to walk. Muscle strengthening and balance exercises play a crucial role in the recovery after the ACL reconstruction.

After 3 months, exercises should get more advanced. The gradual rehab under the supervision of the physiotherapist should be provided for those who are looking forward to getting back to sports and they should be able to do so 9 – 10 months after the surgery. The patient will be recommended to continue with the exercise regime up to full recovery.