Autumn news from the Physiotherapy
Centre
Breaking News
One of our physio's has damaged his cruciate ligament in his
right knee and has undergone surgery to re-construct it.
Here he writes up his experiences and gives some insight
into the structure of the ligament, why it may have snapped on him and what the
reconstructive surgery involves.
My name is Nigel Howell and I am one of the physio's at the
Physio Therapy Centre in Haywards Heath.
I play football twice a week, once on a gym floor and once
on astro turf, or at least I used to!
On the day I ruptured my Anterior Cruciate Ligament (ACL), I
played a 'one off' game on a '3G' surface, which is a matted surface,
resembling grass, which I am not normally accustomed to playing on.
The format was a 'round robin' competition for charity, run
by the Purple Carrot Cafe in Hassocks.
Half way into the competition I twisted my knee and I felt
as if I had been struck by a fast moving cricket or hockey ball on the outside
of my right knee; indeed this was my first irrational thought.
I soon realised that this was not the case and being a physio,
I realised that I had probably caused some major internal structural damage to
the knee.
I hoped it was not the ACL and I was pleased that there was
no immediate and severe swelling, as this is often a sign of a ACL rupture.
After a few moments I got up and realised that I was in big
trouble and that my knee felt completely untrustworthy.
Soon after the incident I went to visit a consultant, who
authorised a MRI scan. I went to see him
for the results two weeks later and it confirmed what we had both been
thinking, the ACL had ruptured.
On a scan the ACL normally looks straight and runs diagonally
in the knee, but my ruptured ACL looked 'crinkly' and only ran about half way
up.
I knew the options, from experience.
a) Try to rehab the knee, without surgery …. By building up
the musculature around the knee and improve control and co-ordination. This
works for many people, but, you must wear a brace if you ski or play football
as twisting/turning sports can be very difficult. There may also be an increased risk of
osteoarthritis in the knee, as the ACL helps to make the knee joint operate in
a normal bio-mechanical way.
b) Opt for the operation, either a hamstring graft or a patella
graft, which both have reported advantages and disadvantages.
My consultant offered me the choice but my gut feeling was
to go for the operation and the Consultant I saw does the ‘patella tendon’ type
of ACL reconstruction.
A week later I was heading to the hospital for the
operation!
If this ever happens to you, you do need to think carefully
about your options and whether you feel the operation is for you!
This will depend a lot on your lifestyle.
If you don’t do much sport or you tend to do ‘straight line’
sports, such as cycling, running or walking, you may well find that you have
enough stability in the knee, after you have done some rehabilitation
exercises, which will be directed by your Physiotherapist.
You should not enter into the operation lightly, as it is
not a small operation.
If you do opt for surgery, comically you would consider
things such as cutting your toenails, before surgery, having good but easy shoes
to slip on & off and have a space in your work diary to take a few weeks
off and if you drive as part of your work, a month, unless you can negotiate
working at home, from two weeks to a month, when you can normally drive again.
Even if you are planning to work from home and your work is mainly desk based, you will still need two weeks off work.
Operation options
1) Patella tendon graft.
You have a tendon, which lies just below your knee cap and in fact
blends with your knee cap, called the patella tendon. If you feel directly below your knee cap, you
can easily squeeze it between your thumb and index finger.
At its lowest most point, the tendon attaches on the shin
bone (tibia) at a place called the tibial tuberosity.
The surgeon cuts into this tendon and takes a rectangular shape out of the middle of it,
‘a window’. They also take a plug of
bone from the tibial tuberosity and a plug of bone from the knee cap (patella).
The surgeon then goes inside the knee with a camera and
removes the remnants of the old ligament with specialised tools and ‘tidies up’
any damage that you are likely to also have done to the meniscus, which are the
two semicircular discs, one on the medial side of the knee and one on the
lateral side of the knee. Normally these
structures help to deepen a joint
slightly, provide shock absorption between the bone ends of the femur and tibia
(thigh bone and shin bone) and help to provide fluid for the joint.
After ‘tidying’ the space within the joint, the surgeon now
uses other specialised tools to drill a hole in the femur and one in the tibia,
one for each of the bone plugs on either end of the Patella Tendon mentioned
above.
With lots of clever techniques, the surgeon then manoeuvres
the new ligament into place, inserting the two plugs of bone into the two bony
holes, with the attached tendon between them. The two plugs of bone are held in
place by small ‘silk screws’.
This is the new ACL
and the operation is complete, once the surgeon has sewn up the ‘portals’,
which are the holes made by the camera and small specialised tools. Then an
injection is put into the knee containing steroid and analgesics, to help with
swelling and pain.
Immediately after the surgery, people have various reactions
to the anaesthetic and surgery, some people will feel very queasy and others
will feel fine and have a good appetite.
After my operation I felt fine and I was also fortunate
enough to have a ‘game ready’, applied to my right leg, which is basically a
top of the range cold compression unit, which intermittently inflates and
deflates and surrounds the joint with very cold water. Personally I found this very relieving.
Depending on your surgeon you will either have a brace on
for two weeks, six weeks or not at all.
On the day of the operation or at the latest the next day
(if your operation is in the evening) you must get up, with crutches and start
to put a bit of weight through your leg. You can put maximum weight through it
if you wish, with your brace on, if fitted with one.
You can go to the loo and shower, but not bath; you have
waterproof dressings over your wounds.
Once the Physio has been and checked that you can mobilise
well, including stairs, if you have them at home and the nursing staff have
checked that they’re happy, you can go home.
Foot note: You wear a T.E.D.
stocking on your un-operated leg, which will help prevent any blood
clots, which can ‘roam’ into your circulatory (blood) system and cause
problems, where the moving clots can cause blockages in sensitive areas, such
as the lungs, heart or brain and cause problems.
You can now follow Nigel’s blog on his progress ….
