Are you confused by all the jargon and medical terms relating to the Anterior Cruciate Ligament? Perhaps you have been diagnosed with a torn ACL and now need to start researching what is involved in an Anterior Cruciate Ligament Reconstruction. Or maybe you have already decided to have ACL surgery and now need to understand some of the words used by your orthopaedic surgeon about the ACL injury, ACL Reconstruction Surgery and the ACL recovery process.
Here you will find definitions and easy to understand explanations of some key terms used in the area of Anterior Cruciate Ligaments which will be helpful to you before and after ACL surgery.
ACL (Anterior Cruciate Ligament): Ligaments are thick pieces of tissue that connect one bone to another. Their function is to provide stability to a joint. Inside your knee there are two important ligaments called cruciate ligaments. They are called this because they cross-over in a cruciform fashion (ie. shaped like a cross). The Anterior Cruciate Ligament (ACL) is important in controlling rotation between the tibia (shin bone) and femur (thigh bone) such as in movements during pivoting sports. The ACL is one of the major stabilising ligaments within the knee. It connects the thigh bone to the leg bone and prevents instability occurring between the two. More specifically, it provides rotatory stability to the knee to allow movements such as pivoting or sudden change in direction to occur without the knee giving way.
Patella: Three major bones contribute to the knee joint. At the front of the knee is a bone called the patella (also known as the kneecap). The other two bones are the femur (thigh bone) and the tibia (shin bone). The patella moves on the femur in a groove called the "trochlear groove". This joint carries a lot of force with bending activities such as climbing stairs and standing up from a seated position. This part of the knee joint is called the patellofemoral joint.
ACL Tear: Also referred to as an ACL Rupture, the most common method of injury is from non-contact activity that typically occurs whilst attempting a pivoting or cutting (change of direction) movement, eg. whilst playing sport. The injury can also occur from contact activity (e.g. being tackled from the side) when your knee buckles inwards whilst the rest of the leg is held in a fixed position.
Arthroscopy: Knee arthroscopy is an operation that uses a specially designed telescope called an arthroscope. This is inserted into your knee through a small incision ( referred to as "key hole" surgery). The arthroscope uses a digital camera through which the inside of your knee can be thoroughly inspected. If needed, any necessary procedures (e.g. removing torn cartilage, ligament reconstructions) can be carried out at the same time through separate small incisions.
Allograft: this refers to the new ACL which is sourced from donor tendons. Allograft is most commonly used in lower demand patients, or patients who are undergoing revision ACL surgery (when an ACL reconstruction fails). For many patients, the strength of the reconstructed ACL using an allograft is sufficient for their demands. Therefore this may be a good option for patients not planning to participate in high-demand sports (e.g. soccer, basketball).
Autograft: this refers to the new ACL which is sourced from the persons own tendon. Numerous studies show that an allograft is not as strong as a patient's own tissue.
ACL Reconstruction: This is a surgical procedure using either the hamstring tendons or the patellar ligament. In the case of the hamstring tendons, two of your hamstring tendons (gracilis and semitendinosis) will be removed from the back of your thigh through an incision on the front of your knee. This is done with a special instrument called a tendon stripper. In some cases (eg. a revision operation), the knee cap ligament (the middle third of the patellar ligament) or the hamstring tendons from your opposite leg may need to be used. A tunnel will be drilled in the top of your leg bone (tibia) and the bottom of your thigh bone (femur). The tendons will be passed through these tunnels and anchored in place with screws and buttons to hold them in place and provide stability to your knee. An ACL reconstruction is sometimes referred to, incorrectly, as an ACL repair. A torn anterior cruciate ligament cannot be "repaired", and must instead be reconstructed with a tissue graft replacement.
CPM machine: A Continuous Passive Motion (CPM) machine is commonly used by orthopaedic surgeons to assist in patient recovery following injury or surgery to the knee joint. After surgery, many patients will experience pain and, as a result, not move the joint adequately enough to regain their full range of motion. The tissue around the joint will become stiff due to this lack of motion and scarring can begin to develop. When a Continuous Passive Motion Machine is applied after surgery, the knee joint can be moved through a defined range of motion for extended periods of time. By increasing the range of motion, recovery time will be reduced significantly, as well as promote healing of the joint surfaces and soft tissues, reduce the development of adhesions and scar tissue, and decrease stiffness of the joint.
Cryo Cuff: The Cryo Cuff is an ice therapy device pack. It provides compression to minimise bleeding and swelling, and cold to minimise pain following knee injury. It can be used with a variety of pumps and coolers to enhance its effectiveness.
While this is a helpful start in understanding some of the commonly used terms relating to Anterior Cruciate Ligament Surgery, it is absolutely essential to broaden your understanding and be well informed in this area as you prepare for ACL surgery and the recovery process that follows. Your medical specialists will give you all the necessary medical information, however the most helpful practical lessons will come from the experiences of others who have had an ACL reconstruction already and successfully completed their ACL rehabilitation program.
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