NIGEL's BLOG

Autumn news from the Physiotherapy Centre

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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 ….