ACL Reconstruction

How The Knee’s Inside Looks Where The ACL Is

The knee is a modified hinge joint with the greatest range of movement in flexion (bending) and extension (straightening). The knee joint is made up of muscle, tendons, cartilage, bones, ligaments, blood vessels, and nerves. In addition, a fibrous joint capsule made entirely of collagen encircles the end of each bone of this joint. All these structures together provide the knee with the proper function and stability.

ACL injuries- Why Are They So Common?

The knee joint is positioned between the two longest bones in the human body, the femur and tibia. Its unique position and its role in weight bearing makes it especially vulnerable to injuries.

The primary knee stability is achieved through knee ligaments, while muscles around the knee play a smaller role, although both work together to help the knee function normally. The knee is reinforced by two collateral ligaments, one on the inner side and another on the outer side, as well as two stronger ligaments (the cruciate ligaments). All these ligaments help prevent abnormal motion.

What is the anterior cruciate ligament (ACL)?

The ACL is considered the main stabilizer of the knee, contributing to about 85% of the knee stability. It connects the tibia (leg bone) to the femur (thighbone) and helps prevent instability (abnormal movement) occurring between these two bones. Specifically, the ACL provides excellent rotatory stability and easy movement, allowing sudden changes in direction or pivoting to happen seamlessly.

Range of ACL Repair Services

Dr. Daouk offers:

• ACL reconstruction
• Revision ACL reconstruction
• ACL repair
• All inside ACL reconstruction
• Meniscus repair

Symptoms and Signs of an ACL Injury

A strain or twist in the knee can cause:

• A “Pop” – Many patients will feel or hear a “pop” when their anterior cruciate ligament tears.
• Significant pain in the knee
• Immediate swelling indicating that the ligament is injured
• Unstable or buckling sensation at the knee joint

ACL Reconstruction

ACL Reconstruction is all about timing. Unrepaired ACL injuries are often accompanied by some damage to the knee’s other soft tissue structures as well as instability. Most patients will not be able to return to sports with a complete ACL tear. Sometimes patients choose to defer the operation. However, without the ACL to stabilize the knee, it is possible that more damage may occur to other structures in the knee, such as the meniscus or joint cartilage. Dr. Daouk generally recommends that younger, active patients consider getting the surgery done sooner rather than later to restore their stability and to minimize the risk of further injury.

How Are ACL Injuries Diagnosed?

Dr. Daouk is a highly experienced, board-certified, and fellowship-trained orthopedic surgeon in Orlando. He is renowned for his expertise in ACL reconstruction and repair. The doctor is thorough in his treatment approach, which is evident from the moment you go in for your first consultation. He would typically follow these steps:

• He will look at your medical history and ask you questions relating to the injury or activity that you were performing when the injury occurred.

• The doctor will examine your knee, performing manual tests to determine what level of instability exists. Some standard tests include the Pivot Shift Test, Anterior Drawer Test, and the Lachman Test. These physical examinations will help him determine the level of movement in the tibia in relation to your femur to confirm if there is any knee instability.

• Muscle spasms, swelling, and pain are common in the injury’s early stages. These symptoms can make it challenging for the doctor to use manual tests correctly for accurate diagnosis. Occasionally, other tests may be required to help confirm the diagnosis.

• X-rays will be taken to check for arthritis, bone chips, and fractures.

• Since the X-rays can show only bone, he may ask you to get an MRI (Magnetic Resonance Image) to assess how much damage the cartilage, tendons, ligaments, and soft tissue have suffered.

In most cases, he can make a diagnosis with the above history, exam, and tests. Since many different types of injuries can occur in the knee joint, he will go through all these steps before diagnosing whether you have a torn or damaged ACL.

Treatment of an ACL Injury in Orlando

Dr. Daouk will recommend RICE and usually medications for the immediate treatment of this injury. It is an acronym for:

• Rest your knee and keep the weight off it by using crutches while walking
• Ice helps reduce swelling, so apply an ice pack for at least 10-15 minutes, three times a day
• Compress your knee using a wrap, as this helps reduce swelling. Do not wrap the bandage very tightly.
• Elevate your leg- it helps minimize swelling in the knee

In some cases, Dr. Daouk may drain excess fluid from the joint to reduce pressure. Once the initial symptoms of the ACL injury have subsided and he establishes the diagnosis, the surgeon will consider your activity levels and the history of the knee injury to determine the most suitable treatment plan. The two standard ACL injury treatment options are:

1. Non-Operative ACL treatments with bracing and rehabilitation

This treatment works only for about 20% of patients. The ones that do well without any surgery are:

• Less active
• Older
• Those who are okay with reducing their physical activity
• Ones that can avoid pivoting their knee joint

These patients may expect a reasonably good outcome by learning to adjust and cope with their ACL injury. However, it is essential to note that a torn ACL will not heal by itself, and in most cases, surgery is the best solution.

2. ACL reconstruction surgery in Orlando(Dr. Daouk will discuss the different surgical and graft options). Patients for whom the doctor will generally recommend surgery are:

• Active people that participate in sports like football, skiing, tennis, basketball, or soccer, all of which involve pivoting
• Those who experience instability despite going through a physical rehabilitation program
• Individuals with injuries involving multiple ligaments