Anterior Cruciate Ligament (ACL) Tear
Ligaments are the strong tissues that connect a bone to another bone. Ligaments are very important in joint stability, by holding the bones in a joint together.
Excessive tension on a ligament will cause injury, also known as a sprain: A grade 1 sprain is a stretch injury to the ligament, without damage to its structure. These injuries typically heal rather quickly, with little long-term problems. A grade 2 sprain involves microscopic damage to the ligament, but the ligament remains structurally intact. These painful injuries will usually heal well, but often the joint needs to be supported while the ligament heals, up to 6 or 8 weeks. A grade 3 sprain involves actual disruption of the ligament, and may render a joint unstable. Depending on the location of the injury, the ligament may or may not heal on its own, and surgery to repair the ligament may be necessary for these injuries.
The arthroscope is a fiberoptic camera that allows the Orthopedic Surgeon to see inside many of the joints in the body, without having to cut those joints open with a large incision. The Arthroscope is a long thin tube, shaped like a straw. They come in various sizes, depending on the size of the joint that is being examined. A camera is attached to the end of the Arthroscope that is outside the body, and this is connected to a television monitor. Thus, one can see the inside of a joint clearly, and magnified many times, on the television monitor in the Operating Room. Often, irrigating fluid is pumped into the joint through the arthroscope cannula, to distend the joint, control any mild bleeding, and improve visualization. Frequently the interested patient can watch along with the rest of us in the Operating Room (only if they want to!)
With the arthroscope, we can now visualize the shoulder, elbow, wrist, hip, knee, and ankle joints. In most cases, the arthroscope gives us an even better picture than if we had to cut open the joint, and is often the only way to visualize certain structures in the body.
During the initial development of the arthroscope, its value was primarily in diagnosis. Now however, many procedures have been developed with arthroscopic techniques, and new arthroscopic instruments have been designed. Often the arthroscopic procedure is superior to the open technique, as there is no need to open a joint and cause additional trauma and scarring. Damaged tissue can be removed or repaired, and many highly sophisticated reconstuctive procedures are performed using the arthroscope.
There are many potential advantages to arthroscopic surgery. In addition to superior visualization, the avoidance of a large incision means less pain, less scarring, and faster healing. Usually only a few tiny puncture wounds are required, and these heal in a few days. This allows earlier motion (when appropriate), and better results.
There are some limitations to arthroscopic surgery, and certainly not every procedure is appropriate for this technique. A well-performed open procedure is always superior to a poorly performed arthroscopic one, and the operating surgeon needs to know his abilities and limitations. There are usually advantages and disadvantages with regards to arthroscopy, and these need to be discussed in detail with your doctor.
Arthroscopic Surgery requires extensive training for the Orthopedic Surgeon. Many courses exist to help surgeons learn new techniques. The Arthroscopy Association of North America is an organization devoted to advancing the arthroscopic knowledge and abilities of its members.
Left untreated, ACL tears do not heal on their own. Persistent knee instability may predispose the knee to early wear, leading to arthritis. Patients with a damaged ACL are at much higher risk for causing additional injury to their knees, including meniscus tears and cartilage injuries.
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