ACL Injuries: Diagnosis, Treatment, and Recovery Options

Cruciate ligament

I would like to ask, last year while playing basketball, I injured my left knee.
After I was able to walk again, I noticed instability and a tendency for my knee to shift, and I am prone to sprains.
When the weather changes, I feel discomfort.
Last week, I went to the hospital for an examination, and the doctor said there might be a tear in my anterior cruciate ligament (ACL).
The doctor recommended that I undergo an MRI and bring the results back to the hospital for further evaluation to decide whether surgery (arthroscopy) is necessary.
I have completed the MRI and have a copy of the images.
I am currently considering which hospital to go to for treatment.
Can you provide any recommendations? Also, what is the approximate cost of arthroscopic surgery? Will I need to be hospitalized? How long is the rehabilitation period?

abc, 20~29 year old female. Ask Date: 2005/08/09

Dr. Zhou Lizhi reply Orthopedics

Knee injuries due to sports can lead to anterior cruciate ligament (ACL) tears, necessitating ACL reconstruction surgery.
The cruciate ligaments consist of the anterior cruciate ligament and the posterior cruciate ligament, both of which can currently be surgically repaired.
The materials used for the reconstruction can be classified as synthetic or autografts.
Generally, synthetic ligaments are utilized for athletes, but they have an average lifespan of about six years and are not covered by health insurance (costing approximately tens of thousands of NT dollars).
Autografts are most commonly harvested from the knee or the knee's lateral ligaments.
This surgery is also not covered by health insurance, but the drawback is that the graft must be taken from the patient's own tissue.
Rehabilitation typically begins around three weeks post-surgery.
Our orthopedic department is also engaged in performing this type of surgery.

Reply Date: 2005/08/09

More Info

Understanding ACL Injuries: Diagnosis, Treatment, and Recovery Options
Anterior cruciate ligament (ACL) injuries are common among athletes, particularly in sports that involve sudden stops, jumps, or changes in direction. These injuries can lead to instability in the knee joint, making it difficult for individuals to perform daily activities or participate in sports. Based on your description, it seems that you may have sustained an ACL injury, which is characterized by symptoms such as knee instability, swelling, and difficulty with certain movements.

Diagnosis
The diagnosis of an ACL injury typically involves a combination of a physical examination and imaging studies. During the physical examination, a healthcare provider may perform specific tests, such as the Lachman test or the anterior drawer test, to assess the stability of the knee. If an ACL tear is suspected, an MRI (magnetic resonance imaging) is often recommended. An MRI provides detailed images of the soft tissues in the knee, allowing for a clear assessment of the ACL and any associated injuries to other structures, such as the meniscus or cartilage.

Treatment Options
The treatment for an ACL injury depends on several factors, including the severity of the injury, the individual's activity level, and their personal goals. There are generally two main approaches: conservative management and surgical intervention.

1. Conservative Management: For individuals with partial tears or those who do not engage in high-demand sports, conservative treatment may be sufficient. This typically includes:
- Physical Therapy: A structured rehabilitation program focusing on strengthening the muscles around the knee, improving range of motion, and enhancing stability.

- Activity Modification: Avoiding activities that exacerbate symptoms, such as pivoting or jumping.

- Bracing: Using a knee brace to provide additional support during activities.

2. Surgical Intervention: For individuals with complete tears or those who wish to return to high-level sports, surgical reconstruction of the ACL may be recommended. The most common procedure is arthroscopic ACL reconstruction, where the torn ligament is replaced with a graft (either from the patient or a donor). This procedure is minimally invasive and typically requires a short hospital stay.

Recovery and Rehabilitation
Recovery from ACL surgery involves several stages:
- Initial Recovery: After surgery, the focus is on reducing swelling and pain management. Crutches may be used to assist with mobility.

- Rehabilitation: A physical therapy program will be initiated, usually starting with gentle range-of-motion exercises and gradually progressing to strength training and functional activities. The rehabilitation process can take anywhere from 6 to 12 months, depending on the individual’s progress and the demands of their sport.

- Return to Activity: The decision to return to sports is typically made in consultation with your healthcare provider and physical therapist. It is crucial to ensure that the knee is stable and strong enough to handle the stresses of athletic activity.

Cost and Hospitalization
The cost of ACL surgery can vary widely based on factors such as the healthcare facility, geographic location, and whether the procedure is performed in an outpatient or inpatient setting. On average, the total cost for ACL reconstruction can range from $5,000 to $20,000 or more, depending on these factors. Most patients undergoing arthroscopic ACL reconstruction do not require an overnight hospital stay, but this can depend on individual circumstances and the healthcare provider's protocols.

Conclusion
If you are considering where to have your surgery, it is advisable to seek a facility that specializes in orthopedic sports medicine and has a good reputation for ACL reconstruction. Discuss your options with your healthcare provider, and consider getting a second opinion if you have any doubts. The key to a successful recovery is adherence to the rehabilitation program and open communication with your medical team. With proper treatment and rehabilitation, many individuals can return to their pre-injury level of activity and enjoy a full recovery.

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