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Minimally Invasive Anterior Cruciate Ligament (ACL) Reconstruction Using Quadriceps Tendon

By: S. Evan Carstensen, MD

The ACL provides anterior and rotational stability to the knee.  However, more than 100,000 ACL tears occur every year in the United States leading to instability and possibly earlier degeneration of the cartilage in the knee. Patients often tear their ACL and feel as though they cannot “trust” their knee.  The ligament tear is diagnosed on physical exam and often confirmed by magnetic resonance imaging (MRI).

ACL reconstruction is completed arthroscopically using small incisions around the knee allowing a camera to view the inside of the joint.  In younger patients, the ACL is typically reconstructed using a patient’s own tissue (autograft) while alternative options include graft taken from a cadaver (allograft), though these rupture at a significantly higher rate.

Various techniques exist to harvest a patient’s hamstring tendons, patellar tendon, or quadriceps tendon for use as a replacement for the ACL.  Historically, the patellar tendon or hamstrings have been used as the graft for reconstructing the ACL.  Patellar tendon requires a long vertical incision on the front of the knee which may lead to anterior knee pain.  Alternatively, hamstring tendons may yield a graft that is too small and at higher risk of rerupture. Newer techniques include use of an all soft tissue quadriceps tendon graft which is harvested through a small (1-1.5cm) horizontal incision above the kneecap. This incision not only heals better cosmetically, but also yields a more consistent graft size that can be specially tailored to the needs of the patient with less graft site pain. 

The quadriceps tendon autograft has been used in a wide array of patients from recreational to professional athletes with excellent outcomes.  Additionally, it can also be used in revision ACL reconstructions where a patient has previously had their ACL surgically reconstructed.  Given the excellent outcomes, less graft harvest pain, better cosmesis, and graft consistency, quadriceps tendon autograft should be considered for your ACL reconstruction.

If you have a painful knee that keeps you from performing even simple activities without discomfort, you may be a candidate for knee replacement surgery. This is a procedure in which the damaged part of the knee joint is removed and the surface shaped to hold a metal or plastic artificial replacement joint. The surrounding ligaments and muscles provide function and support for the replacement. Here is what you can expect after surgery:

1. Your Hospital Stay

After surgery, you can expect to be in the hospital for three to five days. You will be standing and moving your reconstructed knee the day after surgery. A walking device will steady you until your knee is able to support your full weight.

2. Physical Therapy Help

Depending on your condition after surgery, you will either be sent to a rehabilitation facility for a few days, or directly home, where a physical therapist will assist you a few days a week for the first couple of months.

3. Precautions to Take After Surgery

  • Do not pivot or twist on the leg for at least six weeks
  • Keep the knee as straight as you can while in bed
  • Avoid kneeling and squatting
You should be able to walk normally in about six weeks. Contact Alabama Bone & Joint Clinic in Pelham at 205-621-3778 to learn more about getting knee replacement surgery.

Dancing can take a physical toll on your body. Joints and tendons in the knees that can see excessive wear and tear from repetitive movements are especially prone to injury. There are several knee problems to be aware of.

1. Patellofemoral Syndrome

This syndrome causes pain in the front of your knee and kneecap which is especially noticeable when it is painful to put weight on a bent knee in situations like walking down stairs or jumping. Usually caused by poor leg alignment due to unequal lateral pull from the quadriceps, common, external rotation of a dancer’s knee joint can wear down the cartilage in this area.

2. Patellar Tendonitis

Pronation and other improper foot alignments can strain and inflammation of your patellar tendon. This results in patellar tendonitis, which can start out only being painful only during times of activity but advance into continuous pain. Unless you take immediate action, the tendon can tear or degenerate.

3. Iliotibial Band Syndrome

If you have pain or tenderness toward the outside of your knee, especially after you dance, you may have iliotibial band syndrome. Dancers with uneven legs or weak lateral hip muscles are especially prone to this syndrome. Physical therapy can help strengthen the specific muscles necessary for healthy dancing and reduce pain while dancing.
Dancing can be a beautiful and enjoyable activity. Being aware of potential knee injuries can help you stay heathy. For more common knee injuries dancers should watch out for, contact Alabama Bone & Joint Clinic in Pelham at 205-621-3778.

When your doctor tells you that you require an arthroscopy, he or she will go over all the details with you in person. However, here are a few basics of the procedure in case you want to familiarize yourself with the treatment beforehand.

What is it?

Arthroscopy is a procedure requiring surgery in order for a medical professional to diagnose or treat a problem in a patient’s joints. It involves placing an arthroscope, which is a tiny tube containing lenses and fiber optics, through a small incision in the skin. With the attached video camera, the doctor is able to examine a particular joint to determine the extent of a problem. The size of the arthroscope typically varies from 0.5 millimeters to five millimeters in diameter.

Why is it Preferred?

This type of surgery has been conducted since the 1960s, so it has a long history of success and is widely trusted in the medical field. In addition to providing patients with diagnoses, it is also good to actually perform surgery in a way that leads to reduced pain and less trauma to the tissue. Anesthetic is generally given to patients before conducting this treatment.
If you have any questions or concerns prior to your arthroscopy, make sure to bring them up to your medical provider. If you have joint pain, then contact Alabama Bone & Joint Clinic in Pelham at 205-621-3778.

Surgery can be stressful for many reasons. The time off work and away from your everyday tasks can take its toll, but physical therapy can help. Physical therapy after surgery is important for many reasons including:

  • Restoring normal movement
  • Building strength
  • Easing pain
  • Reduce risk of blood clots

Range of Motion

After surgery, your joint may be stiff or swollen. Physical therapy will help you restore normal movement in your joints and help to build strength in the joint and surrounding muscles. As you use physical therapy to steadily improve range of motion, you will be able to return to work and other normal activities more quickly.

Easing Pain

In the days and weeks following surgery, you may feel pain and discomfort in the joint and surrounding area. Physical therapy after surgery can help ease pain and swelling. Just small amounts of rehabilitation at home or with a physical therapist can help with pain and reduce your dependency on pain medications.

Improve Circulation

Your mobility may be limited after surgery. Physical therapy helps you move the joint and your limbs, which improves your circulation. When you move the affected area and increase blood flow, you help reduce your risk of complications such as blood clots. To learn more about physical therapy and how it can help you after surgery, call Alabama Bone & Joint Clinic in Pelham.

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