Still Walking With Crutches After One Month?

Picture from Goal.com

Neymar Junior is definitely a world class footballer who just had an ACL reconstruction after tearing his anterior cruciate ligament (ACL) on 181023. However, his rehabilitation does not seem world class at all. 

You can hear him yelling when his knee is being forced to bend (knee flexion) with 3 people involved. I am not sure if the video was put up just to garner more views, but that is not what to do if you want to improve knee bending range. Getting full extension (knee straightening) is more important early on to avoid any chance of getting a cyclops lesion. 

And still walking with crutches after one month? Our patients are sometimes discharged and walking with no crutches from the hopsital or our clinic after a few days.

Come see us in our clinics if you need rehabilitation after your your ACL reconstruction.

Which ACL Graft is Less Likely To Tear Again?

Post op -view from the front

In all my years of being a physiotherapist, I have treated many patients and athletes who tore their anterior cruciate ligament (ACL) and opted to have surgery to repair it. 

View from the back

In the earlier days, the bone patella tendon bone (BTB) graft and the hamstring/ gracilis (HS) graft were the more popular choices. Allografts (cadaver graft) were not popular then, but they are definitely more accepted now.

I've had many patients (not just the athletes) who subsequently re-tore their HS graft. However, I have yet to encounter a patient who re-tore their BTB graft.

If my observations were accurate, surely then the BTB graft would be the 'better' and 'stronger' graft? Now it seems like there is evidence supporting my observations.

Researchers studied 770 patients (14-22 years) who were injured playing sports and had a six year follow up period. These patients had one normal un-injured knee and the injuredACL knee was reconstructed using the BTB or HS graft. Average age of the subjects was 17 years, of which 48% were female.

There were 492 (64%) BTB grafts and 278 (36%) HS grafts.

The chance of a subsequent  tear on the same reconstructed knee at six years was 9.2% compared to 11.2% in the uninjured normal knee. If it was either knee, the rate goes up to 19.7%.

The three most likely predictors of a subsequent re tearing of the operated knee were knee ligament laxity prior to knee operation, graft selection and age.

Those patients who had a HS graft were 2.1 times more likely to re-tear their ACL graft compared to those who had the BTB graft.

Choosing your graft after tearing your ACL will definitely be influenced by discussions with your doctor, surgeon and physiotherapist etc. Moreover, besides the BTB and HS grafts, you can also use an allograft (cadaver) now. 

Please bear this information in mind if you were to tear your ACL. Please come talk to us if you have any questions.

Reference

Spindler KP, Huston LJ, Zajichek A et al (2020). Anterior Cruciate Ligament Reconstruction In High School And College-age Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates? 48(2): 298-309. DOI: 10.1177/0363546519892991.

R knee

What Do You Do When Your Child Tears His ACL

I was at the supermarket yesterday when I met a patient of mine and his wife. After we exchanged greetings they informed me that their teenage child had just tore his anterior cruciate ligament (ACL) during football training at the Singapore Sports School recently. 

A MRI scan taken confirmed that the ACL was torn. In addition, to complicate matters,the MCL and meniscus was also damaged and there was some bone bruising as well. They then asked for my opinion on what he should do. 

I thought writing about our chance encounter would be really helpful for other parents too and so this is how today's post came about.

My immediate suggestions were to settle the inflammation, regain pain-free full range followed by strengthening the muscles around the knee joint before deciding whether he needs to reconstruct his ligament. All of which are covered in this post in our other blog.

Concurrently, they probably needed to consult a surgeon or two as to whether he needed surgery. In an earlier post, we discussed a published study in which active adults who opted for specialized rehabilitation  after tearing their ACL may not need the operation as their knees were found to be clinically stable and had no real loss in function even five years later. 

However, their teenage son is definitely different from the active adults studied. Evidence suggests that athletes definitely perform better with a reconstructed knee. They definitely needed to discuss at length with their surgeon and their son as well whether he wants to resume competitive sports. I suggested that their son be present at these discussions as he may need to explain his own medical history to his future coaches and subsequently when he reports for national service in the army as well.

One important consideration would be the graft the surgeon chooses to use. Some studies suggest that using the hamstring graft means the hamstring muscle remains weakened even up to five years after the operation despite rehabilitation. There are also cadaver ligaments although a number of studies show that these frozen and sterilized tissues may not be as strong as the bone patella tendon or hamstring option.

One final suggestion was for their child to remain in close touch with his team. He should attend training sessions and games still and help with the coaching staff if necessary. this ensures he feels he's still part of the team and keep his spirits up.

* Picture from richseow - Raffles vs ACJC  'A' Division semi finals match, 2013.

You May Not Need That ACL Operation

Here's a  follow up post to our current trends in ACL reconstruction management. You may not need an operation as you thought after tearing your ACL despite what your surgeon or your friends tell you, especially if you are still young.

I posted the article in our other blog. Go take a look.

*Picture from flickr.com