Reconstructive Surgery Literature Review

LITERATURE REVIEW

TREATMENT: Bracing, Crutches and Rehabilitation

Once an anterior cruciate ligament has been injured, treatment has to be carried out as soon as possible. Due to the location of the ACL (at the level of the knee) it poses significant problems for activities of daily life such as walking, climbing and sitting. Depending on the severity of the injury, an ACL reconstruction surgery may be performed. During this reconstructive operation, the deficient ligament is repaired using a tendon graft. In most cases the hamstring will be used for the tendon graft (Mannel, Marin, Claes & Durselen, 2004). Now whether or not a person has had the reconstructive surgery or not, a functional leg brace in order to protect and heal the injured

This is a concern because it slows down the healing process and it hinders people from returning to activities of daily life. In this study by Melegati et al (2003), two sets of subjects underwent ACL reconstructive surgery with grafts collected from the same site and the patients adhered to duplicate physical rehabilitation procedures. One group remained braced in full extension for the week following surgery, while the second group remained locked from 0° to 90°. The patients locked in full extension for one week were better able to restore complete knee extension over an eight week period than the group allowed immediate 0° to 90° range of motion (Melegati et al., 2003). This is a serious finding as extension deficits are a common impediment following ACL reconstruction. Regardless of whether bracing provides any benefits or not, these benefits are irrelevant if the patient does not comply with treatment procedures (Melegati et al., 2003). While some patients might demand to use a brace post operatively due to supposed benefits and improved security, others might choose to forego a bracing protocol altogether mentioning pressure sores, brace slippage, and decreased range of motion as primary fears (Melegati et al., 2003). The use of postoperative braces following ACL reconstruction remains controversial. The literature

Through the use of its hand grips, crutches reduce the burden an injured portion of the lower body must tolerate by relocating part of the load to the arms and upper body (Faruqui & Jaeblon, 2010). Experts recommend that crutches be used in pairs to foster stability and ensure the best possible sequence and manner of moving the legs, or gait. When an individual's ability to withstand weight with the affected limb improves, some experts recommend using a single crutch on the side opposite the injury. When used in such a manner, the injured leg and the crutch move at the same time, and the crutch still offers a degree of weight-bearing assistance (Faruqui & Jaeblon, 2010). Advances in crutch design and construction continue. Ergonomically designed hand grips may allow better control and less fatigue (Faruqui & Jaeblon, 2010). Better contact with the ground may provide more stability, reduce the chance of slipping, and allow the patient to use less energy for a given level of stability. There are two principal types of crutches, including, axillary crutches, which integrate a crutch pad near the top that should be sited just under the armpit, and the shorter forearm crutch, which transfers the load to the arm and upper body through a forearm cuff and hand grips (Faruqui & Jaeblon, 2010). In addition, advances are being made to add mechanical shock absorbers to crutches, which may reduce stress