I have sprained my knee. I worry that my anterior cruciate ligament (ACL) is gone. How is it diagnosed?
MRI confirmed complete rupture of my ACL. Should I consider surgery?
What are the things that I can do at home while waiting for surgery?
What happens on the day of surgery?
What are the things that I should pay attention to at home?
What is the role of rehabilitation?
Your doctors will take a full clinical history and examine your knee. An X-ray will be ordered to look for fracture or dislocation. MRI will be ordered if there is clinical suspicion of soft tissue injury. If your ACL is torn, it can be diagnosed on the MRI.
If you are reasonably young and active, and hope to return to recreational sports which require good stability of the knee, surgery is suggested. It will involve taking a tendon from your knee as a graft to reconstruct the damaged ACL. The surgery will be done with the assistance of an arthroscope.
Before proceeding to surgery there is work for you to do in the gym and at home. It is well-established that improving the knee function in the pre-surgical phase has a positive effect on post-surgical outcome. You should aim at reducing the knee swelling, restoring your knee extension range of motion, and strengthening your quadriceps.
You should skip breakfast and not to drink while waiting for surgery. The surgery will be done under general anaesthesia. After the surgery, a bandage will be put around your knee. You may be asked to stay overnight at the hospital for observation.
You can start walking on the next day. A pair of crutches will usually be required and you can gradually wean them off in a week or two.
During the first week after the surgery, it is advised to elevate the operated leg as much as possible. You can apply ice on your knee to help relieving the swelling. You can shower but be careful not to soak the dressing. Your doctor will also prescribe oral analgesics.
Your doctor will schedule a clinic session for you in a week or two. During which your surgical wound will be inspected. Most of the time the stitches will be removed after two weeks.
You will work closely with a team of physiotherapists on a tailor-made protocol. The first phase will focus on knee swelling control and regaining the motion to the knee joint and the surrounding muscles. The second phase will focus on strengthening designed to protect the reconstructed ligament, which will gradually increase the stress across the ligament. The final phase will aim at a functional return tailored for your sports.
Dr. WAN, Keith Hay-man