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9 tips: preparing well for anterior cruciate ligament surgery

Een voorste kruisband blessure is een ernstig knieletsel. Wat je kan verwachten en de impact van de blessure op je dagelijkse bezigheden is lastig in te schatten. Hier krijg je van ons tips en adviezen hoe jij jezelf optimaal kan voorbereiden op de kruisband operatie. Een goede voorbereiding is het halve werk. Twijfel je nog of wil je jezelf verdiepen of een voorste kruisband operatie nodig is, lees dan onze blog here.

 

 

What does a preoperative anterior cruciate ligament course consist of?

The preoperative trajectory is the time between cruciate ligament injury and anterior cruciate ligament surgery. In a few, this stretch takes a few weeks, but the average is six to 12 weeks. 

Why am I not having immediate surgery on my anterior cruciate ligament?
  1. You need time to prepare yourself and knee for anterior cruciate ligament reconstruction. 
  2. Not everyone needs surgery to regain proper function.
  3. Waiting for initial consultation with orthopedic surgeon and diagnosis. 
  4. The waiting list for cruciate ligament surgery.
    Detailed answer click here
When are you ready for anterior cruciate ligament surgery?

For optimal results from anterior cruciate ligament surgery, knee function should be almost completely restored preoperatively. This means that the knee should be able to properly extend and flex, minimal swelling may be present, and muscle strength has been sufficiently restored.

Detailed answer click here

What does the preoperative course of anterior cruciate ligament surgery look like?

 During this course, you'll meet your physical therapist, do exercises to help your knee recover, and talk through what to expect from the surgery and rehabilitation afterward.

Detailed answer click here

What exercises can I do after my anterior cruciate ligament surgery?

Exercises include mobilization, muscle training, optimizing circulation and preventing secondary symptoms.

Detailed answer click here

What living rules apply to me after anterior cruciate ligament surgery?

 In the first 4 to 6 weeks, the general rules of life are: do not drive a car, ride a bike or take public transportation. Individual rules apply to everyone and it is wise to discuss this with your physical therapist. 

Detailed answer click here

What does anterior cruciate ligament surgery cost?

The surgery is reimbursed from the basic package. Before surgery, physiotherapy treatments come out of your supplementary package (if you have supplementary insurance for physiotherapy). After surgery, the first 20 physiotherapy treatments come out of your supplementary package. After the 21st treatment, the treatments are paid from your basic package. (Different conditions may apply per individual, always consult with your insurer).

Detailed answer click here

Is there a checklist to prepare for my anterior cruciate ligament surgery?

yes, look here

Is there a homework program for after my anterior cruciate ligament surgery?

yes, look here

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Operate directly

Operation ready

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Preoperative

Exercises

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Living rules

Cost

Checklist

The 9 tips: preparing well for anterior cruciate ligament surgery

Why am I not having immediate surgery on my anterior cruciate ligament?

Top athletes and professional athletes are generally operated on quickly. You can also be operated on quickly, but usually you still have to wait. There are mainly four arguments for this.

You need time to prepare yourself and knee for anterior cruciate ligament surgery.

After rupture of the anterior cruciate ligament, the knee is usually swollen, stiff and muscle size reduced. The preoperative course focuses on recovery both physically and mentally, to prepare you for surgery. In a few, the knee is nearly functionally recovered in a week, but generally takes four to six weeks. Several months to recover is not unusual, but usually there is then more going on than just a torn anterior cruciate ligament (e.g., cartilage defect, multi-ligament injury, etc).

Not everyone needs surgery to regain proper function.

People are usually in a hurry and tend not to want to give natural recovery a chance. Broken is broken, but because of this, there is a chance that a group of clients will have unnecessary surgery. Multiple studies also show that not everyone needs surgery. For example, there is a chance for spontaneous repair of the cruciate ligament. You can, in consultation with your physio and/or doctor, decide to go for a conservative course. Should it eventually turn out that your knee is unstable with sports or daily life, then a cruciate ligament operation can still be considered. Surgery is also still possible after a year (not always desirable). In conclusion, the time you invest in your recovery is not wasted time and generally pays for itself in a smooth rehabilitation.

Waiting for initial consultation with orthopedic surgeon and diagnosis.

Usually, you will have completed a course of treatment with the family doctor and/or physical therapist before seeing the orthopedic surgeon. Most orthopedists have a waiting list for an initial consultation. Scheduling an MRI and discussing the results also takes time. Your patience is tested to a greater or lesser extent. With the advent of focus clinics, the flow has improved.

The waiting list for cruciate ligament surgery.

If you qualify for anterior cruciate ligament surgery, you will find that there is usually a waiting list for this, too. Orthopedic surgeons are busy. How long an operation takes varies by institution, type of injury, level of sport, etc.

 

 

When are you ready for anterior cruciate ligament surgery?

There are three criteria a knee must meet for optimal recovery.

  • Full extension and preferably a fully recovered flexion (>120 degrees).
  • No to minor swelling.
  • Force difference of less than 20% between the two legs.

Of course, the above condition cannot and need not always be met. For example, in the case of a locked knee after a meniscus injury (bucket handle lesion). Research and experience from daily practice show that a knee not (sufficiently) recovered before surgery, goes through a more difficult rehabilitation. But above all, look beyond the knee. Is the timing of surgery right, are you ready for rehabilitation etc (read more about planning surgery optimally)

Tips to prepare yourself for anterior cruciate ligament surgery click here.

 

biodex kruisband test

What does the preoperative course of anterior cruciate ligament surgery look like?

Knee rehabilitation before surgery is an important course. Research has shown that rehabbers who are well prepared for anterior cruciate ligament surgery recover better and faster.

The preoperative process

The preoperative course is the process of preparing yourself and those around you for surgery and rehabilitation. During this course you learn to dose the load on the knee. In doing so, you are cycling a lot to reduce stiffness and fluid. You also do exercises to restore mobility (stretching/bending) and of course you do strength training to make the muscles strong again. The development of strength and the difference between the affected and unaffected side can be assessed by means of a Biodex measurement.

The benefits of a preoperative course are that you get to know your physical therapist, learn exercises that will return after surgery and get a reasonable idea of what will be expected of you (discipline, perseverance, commitment, etc).

Other benefits include getting to know the room, equipment and other anterior cruciate ligament clients. Contact with peers generally helps well with expectation management.

The preoperative conversation

A preoperative course usually concludes with a preoperative consultation. During this talk, questions are answered, you are given the living rules for after your surgery and the first exercises. It is generally also appreciated to receive an explanation of the surgery itself and its consequences (pain, blue discoloration and decrease in strength/stability of the knee). If you have never walked with crutches before, you will learn to do so now. Climbing stairs with crutches will also be discussed. Usually you are allowed to put 50 percent load on the operated leg. Fairly soon after surgery you can start using the exercise bike (2-4 weeks. Discuss this with your physio). Tip: orientate yourself already on an exercise bike for home (buy/rent/loan). Also think about help at home. Transportation to the physical therapy practice is another topic to think about. Usually you won't get reimbursed for the cab. Unfortunately, driving your own car, biking or public transportation is not an option.

 

 

9 tips: optimaal voorbereiden op een voorste kruisband operatie

What exercises can I do after my anterior cruciate ligament surgery?

Immediately after surgery, rehabilitation begins. It is important to do knee exercises.

The exercises are divided into 5 groups:

  • Optimizing circulation.
  • Improve flexion and extension.
  • Muscle strengthening exercises.
  • Prevention of secondary complaints (back and hip).
  • Gait training (symmetrical loading)

Exercise program click here.

Buig en strek oefeningen na de kruisband operatie

What living rules apply to me after anterior cruciate ligament surgery?

After anterior cruciate ligament surgery, the muscles are weakened and you are in pain. To recover optimally and safely, there are several rules of life to follow. Here you can read which precepts apply to you.

The precepts

Use crutches for 4-6 weeks. You may put 50 percent load on the operated leg. Standing upright on two legs is 50 percent and standing on one leg is 100 percent. So while walking, about 50 percent of your weight should be absorbed by your crutches.

A general recommendation is not to stand and walk for too long at a time for the first 2-4 weeks, gradually the time and distance can be built up in consultation with your physical therapist.

For the first six weeks, there is an emphatic advice not to:

  • traveling by public transportation (OV). The abrupt braking/pulling and (intrusive) fellow passengers makes public transport unpredictable.
  • cycling outside. Turning around is usually not a problem after a few weeks, but getting on and off is risk as long as the muscles are not strong enough.
  • car to drive. Generally, you are not insured to drive. An exception may be a car with an automatic in case the left leg has been operated on (Check your insurance).
  • to work. For office jobs, the 6 weeks may be shortened and physical occupations extended. Work should be discussed with the physical therapist on an individual basis.

 

 

What does anterior cruciate ligament rehabilitation cost?

An anterior cruciate ligament reconstruction costs money. The consultation with the orthopedic surgeon comes out of your deductible. The preoperative course comes out of your additional insurance or his own costs if you do not have additional insurance. After surgery you will again incur costs and here you can read how it works.

Health insurance and the anterior cruciate ligament (subhead)

In the Netherlands, insurance is well regulated. Everyone has basic insurance. Still, there are usually many questions about insurance and physical therapy reimbursement.

Conservative: With conservative rehabilitation, physical therapy is not covered by basic insurance. If you have supplementary insurance for physiotherapy, you can use this for guidance during rehabilitation. If this is not or insufficiently the case, you pay the (remaining) physiotherapy treatments yourself.

Operative: After surgery, you usually need intensive physical therapy. The system in the Netherlands is set up so that you need 20 treatments to fall into a chronic care program. From the 21st treatment you are chronically (unlimited medically necessary) insured for one year of physiotherapy from the date of surgery. A referral from the orthopedist is necessary for this.

For the first 20 treatments, you can insure yourself through your supplementary insurance. If you have supplementary insurance for 9 treatments, you pay for 11 treatments yourself. If you don't have supplementary insurance, you pay 20 treatments yourself. One physical therapy treatment costs about 25-35 euros.

Treatment from the supplementary package is not at the expense of your deductible. Once treatments are declared from the basic package, so from 21st treatment, you do pay excess. The operation is also paid from your deductible. The deductible runs per calendar year. If the physiotherapy treatment continues after January 1, you pay your deductible again.

After reading this information about insurance and the deductible, it is quite possible that you have questions or are unclear. The situation may vary from person to person, so always consult with your physical therapist and carefully read the terms and conditions of your insurance.

 

 

Checklist

If you will soon be having anterior cruciate ligament surgery, this is a handy checklist to prepare yourself for the big day and rehabilitation. Click here For the anterior cruciate ligament surgery checklist.

Heb jij ook een voorste kruisband operatie gehad en meer/andere tips dan de 9 tips: goed voorbereiden op een voorste kruisband operatie, laat ze dan achter in de comments. 

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