Anatomic Single- and Double-Bundle Anterior Cruciate Ligament (ACL)
Reconstruction
Patient Information Hand-out & Post-operative Instructions
Freddie H. Fu, MD, DSc (Hon), DPs (Hon)
Robin West, MD
Volker Musahl, MD
Dharmesh Vyas, MD
Updated:
11/1/11
What
is the anterior cruciate ligament (ACL)?
- The ACL is one of the major
ligaments in the knee that connects the thigh bone (femur) to the shin
bone (tibia).
- When athletes “blow out” their knees
– this is the ligament that is commonly torn.
- The injury is very common and its
treatment is a popular topic in medical literature.
- The ACL is important during daily
activities but is absolutely critical to the stability of the knee during
sports that require cutting and pivoting, such as soccer, football and
basketball.
What
does the anatomy of the ACL look like?
- Although
the
- When the ACL is carefully dissected away, it is even
more clear to see where the AM and PL bundle attach to the femur and
tibia. Below you see the AM and PL bundle attachment on the tibia (left)
and femur (right).
- On the femur, there are two ridges that outline the insertion
of the
What
does the ACL do?
- The ACL
provides stability to the knee, while also allowing for normal knee
movement. The AM bundle is tight when the knee is bent and provides
stability in the forward (anterior) direction. The PL bundle is loose when
the knee is bent, and allows for rotation of the knee.7,
21 When
the knee is straight the two bundles are parallel to each other, but when
the knee is bent the two bundles cross each other. Although the two
bundles have slightly different functions, the bundles do not work
independently, but rather they work together to keep the knee stable while
still allowing you to jump, run and play sports.
Are
ACL tears common?
§ ACL tears
are very common. Over 200,000 ACL tears occur each year in the
What
symptoms could I have when my ACL is torn?
§
Usually an ACL tear occurs during sporting
activities. They can be a sudden pivoting or cutting motion, or planting of the
foot while the rest of the body turns.
Patients frequently report “hearing a pop” and often have large swelling
and pain of located in the knee.
How
is an ACL tear diagnosed?
§
The physical examination in clinic is used to
make the diagnosis. This is done through a thorough history of your injury as
well as through a variety of physical exams which include anterior drawer test,
Lachman, pivot shift and KT-2000 measurements. Each of these tests aids in
determining the functional status of the ACL.
§
- Below, an MRI of a torn ACL is shown.
- We can
also use the MRI to measure the size of your ACL. Below is a picture of
someone with a 13 mm ACL on the left, person with 17 mm ACL in the center
and someone with a 21 mm ACL on the right.
- There is much variation in ACL insertion site lengths
(see graph below).
- An ACL insertion site greater than 18 mm allows for
double-bundle reconstruction. If the insertion site is less than 14 mm,
there is only space available for a single-bundle procedure. Between 14 –
18 mm, we can perform either double- or single-bundle reconstruction.
- We can also measure the angle between the ACL and the
femur and tibia (the inclination angle). On the left is a 43° angle,
center is a 47° angle and on the right is a 53° angle.
When
my ACL is torn, do I absolutely need surgery?
§ No. There
are some patients who are able to function without an intact ACL. These
patients modify their lifestyle by eliminating sporting activities that require
pivoting and cutting. However, sometimes
during everyday activities the ACL-deficient knee can buckle or “give way”
(subluxate) resulting in painful episodes with swelling.
§ Importantly,
there is a risk of damage to the menisci (the cartilage shock absorbers) and
articular cartilage (the slippery gliding surface on the ends of the bones)
with each subluxation event. This damage can lead to degenerative arthritis and
subsequent meniscus tears.4
§ Because of
these concerns a majority of active patients elect to undergo ACL surgery when
the ligament tears.
I
just tore my ACL—when will I be ready for surgery?
§ In general,
there are three criteria that must be met before the ACL can be surgically
reconstructed:
1)
Swelling in the knee must go down to
near-normal levels
2)
Range-of-motion (bending and straightening)
of the injured knee must be nearly equal to the uninjured knee
3)
Good Quadriceps muscle strength must be
present. This means that while lying flat on your back you should be able to raise
your leg off the ground while holding it is straight. We call this a “straight
leg raise”.
§ Usually it
takes a couple of weeks after injury before ACL reconstruction can be
performed.
§ The presence
of any associated injuries to the knee joint involving cartilage, meniscus, or
other ligaments may change the time-frame for surgery.
What
happens during surgery?
§ The goal of
reconstructing the ACL is to restore the native anatomy and function of the ACL.
§ Reproducing
anatomy is the primary principle in Orthopaedics, like in the treatment of
broken bones. Below is an example of a broken leg, along with a dislocated
ankle. After restoring the normal anatomy with a metal plate and screws, the
function of the leg and ankle joint are restored.
§ The second set
of pictures illustrates a normal ACL on the left and on the right a
reconstructed ACL. The anatomy and function are restored after the surgery.
Why
does the ACL anatomy need to be restored?
- The
historically standard technique for ACL reconstruction failed to restore
the native anatomy of the ACL5. It
involved some removal of portions of the bone from the femur and then the
new ACL was placed in a position different from the normal ACL2,
11. We
have done many of these ACL reconstructions in the past (see picture
below)11
- Historically,
this standard technique provides good results. At UPMC, we have performed
over 5000 Single-Bundle ACL reconstructions in this manner, from
1982-2003.
- However, there has been evidence in literature to show
that this non-anatomic reconstruction does not protect the knee against
degenerative changes, such as arthritis.9, 12
- Studies done at the
- Therefore, since 2003, we have changed our approach to
doing anatomic ACL reconstruction. We try to preserve the bone and soft
tissue, which allows us to restore both ACL anatomy and function. We
believe this will help protect the long-term knee health.16
What
is an “Anatomic” ACL reconstruction?
§ Every person
is different; some people are short, others are tall. Similarly, each person
has a different size and shape of the ACL. In order to properly reconstruct the
ACL it is important to reproduce each persons individual anatomy.16
§ The goals of
anatomic ACL reconstruction are to:
o Restore 60 –
80% of normal ACL anatomy (see “Goals of Surgery” section later).
o Regain
stability and return to pre-injury activity level
o Maintain
long term knee health
§
The figure below shows a series of 3
dimensional (3D) CT scan of a femur.
On the left is a 3D CT scan of a femur
of someone with a normal ACL. On a 3D CT scan you can only see bone, so you
cannot see the
What is anatomic Double-Bundle ACL reconstruction?
§ In a
“double-bundle” ACL reconstruction, the ACL is restored using two bundles. Just
like the normal ACL, there will be an AM and a PL bundle. In a “single-bundle”
reconstruction, the ACL is restored using one bundle. There are some benefits
of a “double-bundle” reconstruction, when compared to a “single-bundle”
reconstruction.
o
The normal ACL is composed of two functional
bundles, the AM and PL bundle, not just one8. Double-bundle reconstruction
restores these two bundles.
o
Anatomic double-bundle reconstruction better
restores knee stability compared to single-bundle reconstruction.10, 19,
20
o
Because anatomic double-bundle reconstruction
uses two bundles to restore the ACL, it allows for a replacement of a larger size
ACL. For example in the picture below, the patient on the left has a 12 mm ACL,
but the patient on the right has a 23 mm ACL. Using two bundles on the patient
on the right can help to restore more of the normal ACL, where using only a
single bundle on this patient might only restore half of the native ACL size.
What is the surgical procedure for
an anatomic double-bundle reconstruction?
§ The surgical
procedure itself takes between 60 and 90 minutes. You will be in the operating
room between 90 and 120 minutes because we repeat the physical examination of
your knee when you are in the operating room.
§ To
reconstruct the ACL, arthroscopy is performed. This means we look inside the
joint with a small camera using small incisions and instrumentation. We typically
use four small incisions (3 arthroscopic):
–
LP (lateral
portal = incision towards the outside of the knee), MP (medial portal = incision towards the inside of the knee) and AMP (accessory medial portal = incision
even further on the inside of the knee)
–
In the picture above the small incisions are
used for the camera and the surgical instrumentation.
–
One incision over the tibia is used to attach
the new
–
Occasionally, an additional incision is made
on the outer aspect of the knee joint over the femur to help attach the new
- When the camera (arthroscope) is
place inside the knee, we look carefully at the injured ACL. We determine
where and how it is torn. It can be partially or completely torn, and torn
from the top, in the middle or on the bottom. Sometimes, the ACL is still
attached to the bones, but often it is stretched out and has lost its
function.
§
The above picture on the left shows a normal
ACL as seen during arthroscopy. In the middle picture, the whole ACL is torn of
the femur completely. In the picture on the far right the AM bundle is intact.
However, the PL bundle is completely torn. You can see the top of the bundle
where it tore off the femur bone (PL).
§
After the injured ACL is carefully removed,
the attachments (also named insertion sites) of the ACL on the femur and tibia
can be seen.
§
The insertion sites of both bundles (AM and
PL) of the old ACL are marked on the femur and tibia (see picture below).
§
The insertion sites of the AM and PL bundle
are then carefully measured with a small ruler. These measurements will
determine the size of the new ACL
§ A new AM and
PL bundle are created using “a graft”, which can be from donor tissue or from
your own body. The sizes of these grafts are based on your own ACL size. More
about the graft will be explain explained later in this hand-out.
§ To attach
the ACL graft to the bone, tunnels are dilled in the bone. For a double-bundle
procedure (shown below), 4 tunnels total will be drilled: 2 tunnels in the
femur and 2 tunnels for the tibia for the AM and PL bundles.
§
§ The ACL
grafts are then placed into the tunnels and fixed to the femur and tibia bones with
a combination of special fasteners, screws and sometimes staples.
§
After the surgery, X-ray, MRI and CT scan can
be used to evaluate the new ACL.
§
On the X-ray of the knee we can see the
tunnels in the femur and tibia bone. We can measure the angle of these tunnels.
§
On the MRI scan we can see the new ACL. We
can determine if it is intact and if the graft is healing. We can also measure
the angle between the new ACL and the bone and compare this to the angle of
your old ACL. If anatomic ACL reconstruction is performed, the angle of the new
ACL and old ACL should be almost the same like in the picture below (old ACL on
the left, new ACL on the right).
§
On the CT scan, we can see exactly where the
tunnels in the tibia and femur are located. When anatomic ACL reconstruction is
performed, the AM and PL tunnels should be where the normal ACL attachment to
the bone is.
If
I’ve already failed a previous ACL reconstruction or re-tore my ACL after my
previous surgery, can I still do a double-bundle ACL reconstruction on my knee?
§
Yes. In fact, if you’ve already
failed single bundle ACL reconstruction, a double bundle reconstruction is a
very good option since it provides more rotational stability.17
Do
we also perform anatomic single bundle ACL reconstruction?
§ Yes. We perform
single bundle ACL reconstruction in approximately 40% of our patients.
§ However, our
anatomic single-bundle
reconstruction is very different from the traditional non-anatomic ACL
reconstruction that used to be performed. We have learned a great deal from the
development of the anatomic double-bundle technique. We use all of the same
principles to perform an “Anatomic
Single Bundle” ACL reconstruction. 13, 14
§ There are a
few scenarios where we actually prefer to perform single bundle surgery over
double bundle surgery:
- The patient has
a very small native ACL size, usually less than 14 mm. This can be
estimated on MRI, but can only be confirmed at the time of surgery.
- The patient is
still growing and his or her growth plate is not closed.
- The patient has
severe arthritis of the knee.
- The patient has
multiple knee ligament injuries or a knee dislocation and multiple other
ligaments need to be reconstructed at the same time.
- The patient has
bone that is severely bruised.
- The patient has
a small “notch”. This is the open space in the femur bone where the ACL
houses.
§ Above you
can see an example of two different patients. The patient on the left has small
insertion site, measuring only 12 mm. This patient is very suitable for an
anatomic single-bundle reconstruction. The patient on the right has a very
large insertion site, measuring more than 20 mm. This patient is very suitable
for an anatomic double-bundle reconstruction. You can see that both procedures
restore each patient’s individual anatomy.
What
is the surgical procedure for an anatomic single-bundle reconstruction?
§
The procedure is very similar to anatomic
double-bundle reconstruction. However, in stead of drilling 4 tunnels for the 2
bundles, we only drill 2 tunnels because there will be only one bundle. One
tunnel is drilled in the center of the attachment of the old ACL on the tibia,
right between the AM and PL bundle. The other tunnel in the center of the
attachment of the old ACL on the femur (see below).
§
We use an oval tool (called “dilator”) to give
the tunnels an oval shape, just like the normal ACL.
§
Similar to after double-bundle
reconstruction, after single-bundle reconstruction, X-ray, MRI and CT scan can
be used to evaluate the new ACL.
§
On the X-ray of the knee we can see the
tunnel through the femur and tibia. We can measure the angle of these tunnels.
§
On the MRI scan we can visualize the new ACL
and see if it is intact and if the graft is healing. We can also measure the
angle between the new ACL and the bone and compare this to the angle of your
old ACL. If anatomic ACL reconstruction is performed, the angle of the new ACL
and old ACL should be almost the same like in the picture below (old ACL on the
left, new ACL on the right).
§
On the CT scan, we can see exactly where the
tunnels on the tibia and femur are located. When anatomic ACL reconstruction is
performed, the tunnels should be where the normal ACL attachment to the bone
is.
§
Anatomic single-bundle reconstruction has
some limitations when compared to anatomic double-bundle reconstruction.
- It
cannot recreate the two functional bundles (AM and PL) of the ACL.
- It can
cover less of the size of the normal ACL, typically 65-85% of the ACL
insertion site recreated, vs. 80-90% in double-bundle reconstruction.
The
Primary Goal of Anatomic ACL Reconstructive Surgery: Restoring Native Anatomy
§
The goal of anatomic ACL reconstruction is to
reproduce 60 – 80% of the native ACL insertion site area.
§
We take very careful measurements in the
operating room and use a mathematical formula to calculate the area of the
native ACL insertion site that we reproduce during surgery.
§
An example of the calculations is on the next
page.
Percent Reconstructed Area on the Femoral Side
Is
it possible to tear just one bundle?
§ Yes – this
is rare (around 5% of all ACL tears) but does happen.
§ Examination
of the knee in clinic may suggest a one-bundle tear:
- An AM bundle tear
leads to forward-backward instability, but rotational stability may be
intact.
§ In either
case we save the intact bundle and “augment” the ACL with a single bundle
reconstruction – either the AM or PL…whichever one is torn.
§ On the left
is a picture of an intact PL bundle.
The AM bundle was torn, and is now reconstructed with a graft.
§ On the right
is a picture an intact AM bundle.
The PL bundle was torn, and is now reconstructed with a graft.
Where
do the grafts for ACL reconstruction come from?
§ The graft
tissue can come from your own body (autograft) or from a cadaver (allograft).
§ Autograft
options include different tendons from different muscles: Hamstrings Tendons,
Quadriceps Tendon, and Patellar Tendon (BTB).
- Advantages
to autograft include no risk of disease transmission and potentially
quicker healing of the new ACL.
- The quadriceps tendon (above) is
the largest tendon in the body and therefore can allow for either a single-bundle
reconstruction (left) or double-bundle reconstruction (right). The size of
the quadriceps tendon can be measured preoperatively on MRI. A tendon
thickness greater than 7 mm allows for a double bundle reconstruction.
- Disadvantages to autograft tissue
primarily relate to harvesting of the tissue, which can cause pain after
the surgery. The operating time is also longer because the tissue has to
be obtained before the reconstruction.
§ Allograft
options also include a variety of different tendons from different muscles:
Hamstrings Tendons, Tibialis Anterior Tendon, Posterior Tibialis Tendon,
Patellar Tendon, Quadriceps Tendon, Achilles Tendon, and the Tensor Fascia Lata.
Is allograft tissue safe?
§ Yes
allograft tissue is safe. Allograft tissue is comprehensively screened
by tissue banks for diseases such as Hepatitis and HIV.
However, nothing is 100% safe. The risk of HIV transmission is 1 in 1.6 million,
and hepatitis C, which 1 in 421,000.18 These are very minimal risks and allografts
are frequently utilized during ligament reconstruction surgery. For comparison, your risk of being struck by
lightening is higher (73 people are struck and die each year from lightening!)
than your risk of contracting disease from allograft tissue.
Is allograft tissue durable?
§ Yes.
Both autograft and allograft tissue undergo a process of ligamentization
whereby the body’s own tissue remodels the graft. During the remodeling phase,
the graft itself becomes weaker before regaining its strength. The use of
allograft does require a longer time for biological healing than
autograft. After healing of the grafts
occurs, both autograft and allografts are durable.
How does the new ACL heal after my surgery?
§ Typically
the graft heals to the bone through bleeding created by drilling the tunnels.
§ We have
begun using a “fibrin clot” to try to enhance the healing of the two bundles
together as well as the ACL to the bone.
§ The fibrin
clot acts as a structural backbone allowing blood platelets to release lots of
growth factors and other chemical substances, which promote healing.
§ For ACL
reconstruction, the fibrin clot is created from your own blood by gently
stirring 50 – 60 cc in a glass beaker. We draw the blood from your IV during
the surgery.
§ The use of a
fibrin clot is a very cost-efficient way of promoting healing of the
graft. There are no additional costs
involved and there is no risk of disease transmission as it is your own blood.
§ In anatomic
single-bundle reconstruction we sew the clot in the graft. We make sure to
place some of the clot where the graft is located in the tunnel to promote
healing of the ACL to the bone.
§ In
double-bundle reconstruction, we also “sandwich” the clot between the AM and PL
bundle to enhance the healing between the bundles so they can start to work
together to provide stability of the knee (see picture below).
§ We have seen
improved healing of the new ACL with the use of a fibrin clot, compared to when
we do not use it. Below you can see this on MRI. On the left is an MRI 6 months
after ACL reconstruction without fibrin clot. The ACL is not completely healed
and still appears white. On the right is an MRI 6 months after ACL
reconstruction with the aid of a fibrin clot. The ACL is darker, which
indicates that it is in a later stage of healing.
How is the outcome of anatomic ACL
reconstruction?
§ We carefully
follow our patients after surgery and measure knee stability, as well as knee
range of motion. In the picture below you see straightening of the legs and
straight leg raise, bending of the knees, kneeling and strength of the
quadriceps muscle.
§ After
anatomic
§ At UPMC, we
have performed over 500 anatomic ACL reconstructions since 2003, with excellent
results.6
When
can I return to competitive sports?
§
After anatomic ACL reconstruction,
rehabilitation guidelines are usually as follows:
|
DAY OF
SURGERY |
Walking
with Crutches and Brace |
|
1 month
Post-Op |
Discontinue
Crutches |
|
1.5 months
Post-Op |
Discontinue
Brace |
|
3 months
Post-Op |
Jogging
and In-Line Running |
|
9 months
Post-Op |
Sport-specific
drills and functional training with a Brace |
|
9 – 12
months Post-Op |
Gradual
Return to Sports After Functional Training is Complete |
|
1 year
after RETURN TO SPORTS |
Recommend
Use of a Functional Brace |
§
In general, these guidelines should be
followed after ACL reconstruction. However, it is very important to realize that these guidelines may change
depending on each patient. Your doctors may tailor a specific,
individualized rehabilitation program depending on the number of surgeries you
have had, accompanying ligament and meniscal injuries, your individual
progress, and other factors that may impact the healing of you graft.
§
All
guidelines should be followed closely because the new ACL needs time to heal. Remember, returning to sports before the graft is healed
increases the chances of re-injury. Although you may feel “fine” earlier, the ACL graft takes about 9 months to heal.
§
“Why
does an anatomical graft take 9 months to heal?” An
anatomically placed ACL experiences more forces than a non-anatomically placed
ACL and therefore, may be easier to re-rupture! This is because the
anatomically reconstructed ACL sees all the forces that the normal ACL sees,
whereas a non-anatomically placed ACL only sees part of those forces.
§
The
anatomically placed ACL better restores normal knee function, but a longer
period of time is required to protect the graft before you can resume sports
activities.
Below is an example of a
patient who returned to sports too early and re-tore the ACL. The patient was
only six months out from surgery. On the MRI (left) we saw the graft was still
healing (still a white). He returned to sports and re-injured the ACL (right).
Is
rehab different for anatomic single-bundle reconstruction and anatomic
double-bundle reconstruction?
§
No. All aspects of rehab are the
same for single and double bundle ACL surgery.
What
is going to happen with ACL reconstruction in the future?
§
The technique for ACL reconstruction is still
improving. As surgeons, we need to know if we are doing a good job at
reconstructing the ACL. Therefore, we follow our patients to see the results of
our surgeries. We can measure the results in different ways; we can use
physical examination in clinic, questionnaires, radiographs, MRI, and CT. These
tests give us a lot of information, but they may not be precise enough to see
small differences or small improvements in the outcome of a surgery.
§
Cardiology (The Study of the Heart) is far
ahead of Orthopaedic Surgery with regards to research. The exact anatomy of the
heart has been known for a long time. In the past we only had the use of
electrocardiogram (EKG) for diagnosing heart problems. Now, when you have a
problem with your heart, there are much more precise tests; imaging studies can
visualize all the blood vessels in your heart, a stress test can measure the
exact amount of blood flow to every part of you heart while you exercise.
§
In Orthopaedic Surgery we are working hard to
accomplish a similar degree of accuracy. New, more accurate, precise and
reliable tools are being created to measure the outcome of surgery. In the next
paragraph, you will find some of the ways UPMC is trying to accomplish this.
What
research is UPMC doing related to ACL reconstruction?
§
At UPMC we are doing a lot of research on the
ACL. Currently, we have over 60 research projects on the ACL alone. We meet for
3 hours every week to talk about the ACL with a multidisciplinary team of
orthopaedic surgeons, physical therapists, radiologist, engineers, biologist,
other researchers and students.
§
On the next page, we will mention a few of the
most important projects. With all of our research, we are trying to gain more
knowledge about the normal ACL, as well as the reconstructed ACL. This
information is used to improve the treatment for our patients.
§
The University of Pittsburgh is working on
improving the way we measure the outcome of ACL reconstruction. One of our 15
research laboratories, the Orthopaedic BioDynamics Laboratory, has a special
system called Dynamic Stereo X-ray (DSX).
§
This system was designed to look at your
joint while you are moving. It allows us to look at the motion inside your
knee, with 0.1 mm accuracy, while you are running on a treadmill, walking or
jumping. With this system, we were able to show that non-anatomic ACL
reconstruction does not restore normal knee motion.15 Above is a schematic explanation
about how this works. It works for the knee, but also for any other joint in
the body.
§
We just received a grant from the National
Institutes of Health (NIH) to study if there is a difference in outcome between
anatomic single-bundle and anatomic double-bundle reconstruction. Some of our
patients will be asked to participate in this study. A computer system will
determine if they undergo single- or double-bundle reconstruction (this is
called randomization). After the surgery, all patients will be followed with
physical examination, questionnaires, x-rays, MRI, and CT scan for two years.
They will also all undergo testing at the “Orthopaedic Biodynamics Laboratory”
with the system described above. We are excited to find out the results of this
research and we hope this will answer some questions about the outcome of both
anatomic single- and double-bundle reconstruction. \\\
§ We are also
looking at the ACL in animals. There are many animal species, which all move in
a different way and use their knee in a different way. Therefore, animals are a
good example to look at the relationship between the shape of the bones, the
ACL and knee function. Below are a few examples.
Postoperative Instructions:
How do I take care of my surgical
incisions after surgery?
§ The Cryocuff
and wound dressings should be left on for 48 hours
§ After 48
hours:
- Remove the wound dressing and
apply clean band-aids over the incisions. Do not apply any cream,
ointments, lotions or other substances to your incisions.
o
Use the Cryocuff as needed for swelling, 3 to
5 times a day for 20 minutes
o
You may shower but do not soak or submerge
your incisions under water (i.e. take a bath).
o
Please sit down while in the shower (i.e. use
a shower seat).
What
should I be aware of after surgery?
§ The signs
and symptoms of wound infection and deep venous thrombosis (DVT, clots of the
leg veins), should be paid close attention to after surgery. Although rare,
these complications can be very serious.
§ If you
experience any of the following symptoms after surgery, call our office immediately
at 412-432-3611, or go to the nearest Emergency Room for immediate evaluation:
- Fever
(>101.5˚F)
- Chills
- Excessive
redness or swelling around the incision
- Yellow
drainage (Pus) from the incision
- Deep
pain and/or excessive swelling in the calf
- Chest pain,
shortness of breath, or pain with breathing
When
do I follow-up after my surgery?
§ After
surgery, you will be evaluated in the clinic at 1 week, 1 month, 3 months, 6
months, 12 months, 18 months, and 24 months.
§ A physical
examination will be performed at each visit, measuring knee range-of-motion and
stability. Radiographs of the knee will also be taken periodically.
How
long do I have to wear my brace?
§
In most cases, a hinged-knee brace will be
required for a minimum of 6 weeks after surgery.
How
long do I have to use crutches?
§ In most
cases, crutches will be required for 4 weeks after surgery. This may vary if
additional surgical procedures are performed on the meniscus, cartilage, or
other knee ligaments.
How
much weight can I put on my leg after surgery?
§ In most
cases, full weight-bearing is permitted immediately with the use of crutches.
This may vary if additional surgical procedures are performed on the meniscus,
cartilage or other knee ligaments.
What
is a CPM machine, and how often do I have to use it?
§ A CPM
machine is a Continuous Passive Motion device. It straightens and bends the
knee after surgery, until adequate muscle control and range-of-motion is
regained.
§ Typically,
the CPM is initially set from 0 to 45 degrees and used 2 times daily for 2
hours each time (unless meniscal repair is performed). The flexion is increased
10 degrees a day until range-of-motion from 0 to 120 degrees is achieved. This
typically occurs over 2-3 weeks after surgery, at which point the CPM can be discontinued.
§ A CPM will
be provided to you at the hospital on the day of surgery but will not begin
until one week after surgery.
When
do I start Physical Therapy?
§
A prescription for Physical Therapy is given
at the first postoperative visit. The schedule is 1X / Week for 6 weeks, then
2-3 X / Week for 6 - 9 months. A detailed rehabilitation protocol is provided
to the Physical Therapist for Double-Bundle ACL reconstruction.
When
can I drive?
§
Driving is permitted after:
- 1 week
for left knee surgery (automatic transmission)
- 6 weeks
for left knee surgery (manual transmission)
- 6 weeks
for right knee surgery (manual or automatic transmission)
All
images are from Dr. Freddie Fu’s patients, UPMC Center for Sports Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
Contact
Information:
§
Phone: Appointment: 412.687.3900
Email: arrisherlm@upmc.edu
Acknowledgement:
We would like to thank Dr. James J. Irrgang and Ms. Rebecca Singleton for their
help in preparing this handout.
References
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