Postoperative Complications and Care of ACL Reconstructions


Anterior cruciate ligament tear or damage is a common injury in young athletes and people who actively use the knees. Arthroscopic reconstruction of ACL is a popular surgical technique to repair the torn ACL. It is reported that patients undergoing this procedure are benefitted with 85-90% satisfaction with the restoration of functional stability and relief from the symptom.

A study published in the Journal of European Radiology, says that some of the common complications may occur after ACL reconstruction, however, they are very rare. So, it is important for you to understand the risks and complications before undergoing the procedure to make a well-informed decision about the surgery. As is true with any surgery, it is always advisable to have a few more opinions before undergoing any surgery, even a relatively safer surgery such as the ACL reconstruction.

The complications of ACL reconstructions are discussed below:

  • Graft Impingement:

Graft Impingement occurs if the graft gets trapped in the notch between the rounded ends of the femur (thigh bone). It can lead to the abrasion, wear and tear of the graft, causing graft failure. As a result, it obstructs the joint movement, and the patient suffers from decreased range of motion.

  • Graft failure:

Graft failure occurs due to the graft impingement.However, if the graft is ruptured, it can be revised by using the tendon of the other leg.

  • Tibial tunnel cyst:

A Tibial tunnel cyst is a rare complication, which is attributed due to some errors like allograft tissue necrosis, incomplete incorporation of graft tissue, resulting in flowing of the joint fluids into the tunnel.

  • Arthrofibrosis:

Arthrofibrosis is a common complication of ACL reconstruction. It is characterized by formation     of excessive scar tissues within the joint and surrounding soft tissue spaces, causing pain and limits the range of motion

  • Infection:

Postoperative infections are seen in approximately 1 in 200 cases of reconstruction. The infection can be managed by antibiotics orally or by drip. Very rarely, further surgery is done to wash out the infection. Infection leads to pain and swelling, which impacts the motion.

  • Allergic reaction to drugs:

Blood transfusion related complications like heart attack, pneumonia, renal failure, infection of the bladder are reported in some patients. Nerve blocks (anesthesia) related complications like nerve damage, the infection can also happen. Underlying serious health issues may also cause complications, which require prolonged hospitalization.

  • Deep vein thrombosis:

Sometimes, the blood clots are formed in the veins of the leg. In such conditions, your doctor may prescribe you some anti-clotting drugs or medications, which helps in thinning the clots and removes the obstruction in the vein. The anti-clotting medications are available in the form of tablet or injections. Somehow, if these clots go to the lung, it can cause difficulty in the breathing.

  • Stiffness in the joint:

It occurs due to the formation of the scar tissues within the joint. It can be minimized by rapid rehabilitation or advances in the operative technique. However, a full range of motion may not be achieved.

  • Donor site problem:

Donor site referred as the place from where the graft is taken. Usually, the graft is taken from hamstrings or patella for ACL reconstruction. So, the patients may have pain and swelling in these areas, which subsides with time.

  • Damage to the vessels

The surgeon should avoid damaging the small nerves present under the skin during the procedure. Sometimes, they get cut during the procedure and causes numbness in the area, which is minimized with time, and does not cause any functional problem of the knee. In case, if any significant nerve gets cut, it can cause weakness in the leg.

  • Excessive Swelling & Bruising:

The patient may experience excessive swelling and bruising in the soft tissues of the knee, but it typically disappears with time.

  • Problem with the hardware:

In anterior cruciate ligament reconstruction, some hardware devices like screws and staples are used to fix the grafts to the bone. This can lead to irritation or inflammation of the wound. In such cases, screws or staples are removed once the grafts has begun to grow into the bone.

  • Residual pain:

The patients may have if there is any damage to the other structures of the knee.

  • Reflex Sympathetic Dystrophy:

It is a very rare complication and characterized by excessive and unexplained pain.

Post-operative care:

  • The ACL or anterior cruciate ligament reconstruction requires a maximum one-day hospital stay. During that period, you may be given painkiller in tablet or intravenously (drip).
  • If there is any fluid accumulated, it is drained from the knee.
  • Your doctor may give you a splint to make the recovery comfortable for you.
  • A physiotherapist can demonstrate light exercises that can be done at home.
  • Do not touch any waterproof dressing unless your doctor advise.
  • Take ice therapy for 20 minutes over the knee; repeat it frequently.
  • Contact your doctor if you notice any symptoms like pain, redness, swelling without any delay.
  • Postoperative follow-up with your doctor should be done after 7 days.

Rehabilitation

Physiotherapy is one of the most integral parts of ACL reconstruction. In the case of ACL reconstruction, preoperative physiotherapy works excellent in preparing your knee for the procedure.

After surgery also, you should continue the physiotherapy under the supervision of an expert. The activities like cycling can be done at 2 months, and jogging can be done at 3 months after the surgery. With adequate fitness, confidence, and training, one can return to the sports. For professional sportsmen, it takes 6-12 months to go back to the activities depending on the rehabilitation and the other factors.

The optimum success of the procedure and the rehabilitation therapy sometimes get affected if the other structures of the knee such as articular cartilage, meniscus are also injured.

Conclusion:

Anterior Cruciate Ligament reconstruction is considered as one of the successful procedure performed by the orthopedic surgeons. The procedure can give you even 99% satisfactory result if you get it done by a skilled and experienced surgeon. The procedure is highly demanded by the people who wish to get back to the active lifestyle, particularly who are very much interested in sports including running and twisting.

 

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