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Revision ACL surgery

“anterior cruciate ligament… Sixth most common procedure performed by orthopedist, with more than 100,000 ACL reconstruction’s being performed annually in the United States”

In comparison to other types of surgeries, this is not a large prevalence. Anytime there is a surgery though, that injury is important to that one patient. This article cut my attention because of the author Dr. Bach. He practices fairly close to my region and I’ve seen previous patients from him. It’s always helpful to learn about the procedures that physicians perform in your area so that way you can be better prepared to treat the patients that these physicians operate on.

“The definition of ACL failure in simple terms includes symptomatic instability, pain, extensor dysfunction, and arthrofibrosis.”
This essentially means that if there are continued symptoms after the surgery, that the surgery was a failure. I treated one patient previously, not from this doctor, in which the screw from the initial ACL reconstruction was never moved. The patient continues to have pain immediately upon starting therapy and I was beating my head against the wall trying to figure out why the patient continued to have pain. As a physical therapist we hate seeing patients experience symptoms that we can’t control. After sending the patient back to the doctor, it was found that the previous screw was in the joint space and causing the patient’s symptoms.

“Failures that occur within six months of reconstruction can be due to surgical technique, incomplete graft incorporation, and excessive rehabilitation or premature for trying to athletic competition.”

The case described above, is an example of an error with surgical technique. I have also seen cases in which the patient was progressed through rehab to aggressively and the patient continued to worsen over the course of time. We have to honor the patient’s pain response when giving exercises and trying to make progressions.

“Revision ACL reconstruction’s are a “salvage” procedure to allow the patient to perform activities of daily living… Only 54% returned to their pre-injury level of activity”

To phrase this bluntly, let’s get it right the first time. As a physical therapist I will take part of the blame because sometimes our profession may progress patient a little to rapidly. We have to honor the patient’s pain and movement response.
There are a few parts of this article that I found very interesting. The doctors described patient positioning on the table and we are making conscious effort’s in order to reduce lumbar extension for prolonged periods of time in order to reduce strain on the lumbar spine. They went into great detail to describe how they remove the screw or insert the screw deeper from the initial ACL reconstruction surgery. I didn’t know that they could insert the screw deeper instead of just remove the screw all together.

“with the help of a physical therapist, and emphasis is placed on achieving full extension and equaling the opposite knee. Full flexion is usually achieved by 6 to 10 weeks.”

I fully appreciate the special mention a physical therapist in this article. The physicians did not have to describe this portion at the end of the article. PT’s are part of the medical team. If you or anyone you know is recovering from an ACL reconstruction, please seek out a physical therapist by word-of-mouth or through recommendations from friends and family. One could also look online to investigate the therapist that is treating you or your family member. The therapist that you were seeing should be educating you or your family member at each session and explaining the rationale behind each exercise, movement or hands on technique.

Excerpts taken from:

Creighton RA, Bach BR. Revision anterior cruciate ligament reconstruction with patellar tendon allograft: surgical technique. Sports med are thre revision anterior cruciate ligament reconstruction with patellar tendon allograft: surgical technique. Sports med arthrosc review. 2005;13(1):38-45.

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Categories: non-professionals, Physical therapy, PTs, Written BlogsTags:

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