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Please read carefully the information provided below. It is essential that you are familiar with all the steps of your treatment. This will ensure the greatest satisfaction and best possible result of the proposed treatment. The information provided is specific to Mr Vioreanu's practice. All the aspects below will be discussed in depth during the consultation.

For ACL Reconstruction in Children and Adolescents please read:

ACL Injury and Reconstruction ACL Injury and Reconstruction (2273 KB)

Tendon Donation for ACL Reconstruction in Children Tendon Donation for ACL Reconstruction in Children (395 KB)

ACL Injury in Children and Adolescents ACL Injury in Children and Adolescents (2274 KB)

First Consultation
During first Consultation you will meet Mr. Vioreanu to discuss your knee problem. He will determine what, if any, surgery is required.

The consultation will last as long as necessary, depending on the complexity of your knee problem. Mr. Vioreanu will perform a physical examination and will review all your imaging studies.

There is a fee payable for the consultation. Remember to bring the referral letter from the GP or medical specialist.

Appointments are realistically scheduled for all patients, mindful and respectful of time. The nature of medicine and surgery is not always predictable and delays might happen. Your understanding is appreciated during such circumstances.

Appointments are confirmed a week in advance by a letter in the post or an email and with an SMS alert the day prior. 

A cancellation fee is not charged, however a return phone call of inability to attend is appreciated.

Do I Need Surgery?
If you injured your Anterior Cruciate Ligament (ACL) the treatment options are discussed in depth with Mr. Vioreanu during consultation. Depending on your injury, age, desired level of activity and your expectations the recommended treatment will be either conservative (no surgery) or surgery.

Conservative Treatment

Conservative treatment is by physical therapy aimed at reducing swelling, restoring the range of motion of the knee joint and rehabilitating the full muscle power. A detailed ACL Rehabilitation Protocol will be given to you and your Physiotherapist. As the cruciate ligament controls the joint during changes of direction, it is important to alter your sports to the ones involving straight line activity only. Social (non-competitive) sport that does not involve sudden change of direction may still be possible. Skiing is possible with conservative treatment. A brace and adherence to groomed runs may be required.

With conservative treatment there is 1% chance that the knee will return to a satisfactory level of stability and no further surgery is required.(i.e the ACL heals) For some patients Mr. Vioreanu will recommend conservative treatment initially and will ask you to come back after 4-6 weeks of pre-habilitation for a further clinical examination to check your knee stability and give you further advice.

Surgical Treatment

Those patients who wish to pursue competitive ball sports, or who are involved in an occupation that demands a stable knee are at risk of repeated injury resulting in tears to the menisci, damage to the articular surface leading to degenerative arthritis and further disability. In those patients, surgical reconstruction is recommended. Surgery is best carried out on a pain free, healthy joint with a full range of motion. This is achieved with an ACL pre-habilitation program supervised by a Physiotherapist.

Stabilising the joint protects menisci and thus lessening later osteoarthritic degenerative change. Although ACL reconstruction surgery has a high probability of returning the knee joint to near normal stability and function, the end result for the patient depends largely upon a satisfactory rehabilitation and the condition of the joint prior to surgery. Advice will be given regarding the return to sporting activity, depending on the amount of joint damage found at the time of reconstructive surgery.
Risks for Surgery
There are always risks when having surgery, and you need to be fully aware of those risks before making your decision to proceed with surgery. Do not hesitate to ask questions of your surgeon, anaesthetist or of other medical specialists who are managing your health in the lead up to your surgery.

The vast majority of people get through the surgery with no problems at all and will be surprised at how good they feel so soon afterwards. Some will experience minor issues and occasionally there may be more serious complications. These problems are rare and most can be treated quickly and effectively. Below is a list that covers the major risks and complications with arthroscopic surgery. Additionally, there may be other risks, particularly if you have a complex medical history or particular conditions that need to be managed by a medical specialist.

General Complications Related to Surgery.

  • Pneumonia: Patients with a viral respiratory tract infection (common cold or flu) should inform us as soon as possible and will have their surgery postponed until their chest is clear. Patients with a history of asthma should bring their inhalers to hospital.
  • Deep vein thrombosis and pulmonary embolus: Although this complication is rare following arthroscopic surgery, a combination of knee injury, prolonged transport and immobilisation of the limb, smoking and the oral contraceptive pill or hormonal replacement therapy all multiply to increase the risk. Any past history of thrombosis should be brought to our attention prior to your operation. The oral contraceptive pill, hormonal replacement therapy and smoking should cease one week prior to surgery to minimise the risks.
  • Excessive bleeding resulting in a haematoma is known to occur with patients taking Aspirin or Non-steroidal Anti-Inflammatory Drugs - such as Voltaren, Arcoxia, Mobic, Naprosyn or Indocid. They should be stopped at least one week prior to surgery.
  • Infection. Surgery is carried out under strict germ free condition. Antibiotics are administered intravenously at the time of your surgery. Any allergy to known antibiotics should be brought to the attention of the medical staff. With these measures there is a less than 1 in 500 chance of developing an infection within the joint.

Complications specifically related to your knee reconstruction surgery.

  • Postoperative bleeding & marrow exuding from the bony tunnel may track down the shin causing red inflamed painful areas. When standing up the blood rushes to the inflamed area causing throbbing. This should ease with elevation and ice packs. This is a normal postoperative reaction.
  • Due to the skin incision you may notice a numb patch on the outer aspect of your leg past the skin incision. The numb patch tends to shrink with time and does not affect the result of the surgery.
  • Your hamstring musculature will recover quickly. However, scar tissue forms around the reformed tendons. This may tear and is felt as a pop or tear behind the knee on the inner side. This will usually set your rehab back a few days only and usually occurs before 6 weeks.
  • Graft failure due to poorly understood biologic reasons occurs in < 1% of grafts.
Before Surgery

Choosing a date for surgery

After the Consultation, in conjunction with Gwen - Mr. Vioreanu Personal Assistant, you should decide on the time frame and a date that is most suitable to you. 

You will find that we are very flexible and will try to accommodate your requests whenever possible.

Forms to be completed and signed.

You will receive an information package containing your admission, consent and questionnaire forms, which you will need to complete and send back to us.

Mr. Vioreanu collects information about each surgery for the purposes of patient management, but also uses information for research. 
You will be given a consent form, which is to be completed and given back to Mr. Vioreanu’s office.

Let us know.

You should inform us of any medical conditions or previous medical treatment as this may affect your operation.
You should inform us if you prefer to stay in the hospital the night after surgery as we will need to book in advance a bed in SSC.
It is extremely important that there are no cuts, scratches, pimples or ulcers on your lower limb as this greatly increases the risk of infection.
Your surgery will be postponed until the skin lesions have healed.
You should not tape, shave or wax your legs for one week prior to surgery.
Please use HIBISCRUB solution (Chlorexidine 4%) to wash your knee ONCE daily for 5 days prior to surgery. Wash the skin gently and do no scrub the area. You can find HIBISCRUB solution at a retail Pharmacy. 


Pre-operative testing.

You will receive a list of all pre-operative tests required prior to surgery. These are standard tests for all patients.

Managing your Medications.

Prior to your surgery we will discuss your medications with you. You will be given important instructions about what you should and should not take prior to surgery. Please do not hesitate to contact our office if you are unsure about these instructions.
Also, some patients with complex medical conditions will need appointments with other medical specialists to ensure that it is safe to proceed with surgery.
We will let you know if this is something you need to do.

Physiotherapy & Crutches.

As this is a day-procedure in some cases you will see a Physiotherapist in SSC before heading home. They will ensure you are walking safely with the aid of crutches and will give you instructions for the next few days.

We strongly advise that you arrange to see your local Physiotherapist the first few days after surgery. A set of crutches will be provided by SSC after surgery. Please print our specific ACL Pre- and Re-habilitation program and bring it to your local Physiotherapist so they will follow our recommended program.

Please inform us the name of your local Physiotherapist and we will communicate with them regarding your specific rehabilitation program.

The night before surgery.

Please do not eat and drink after mid-night and try to have a good nights sleep.
During Hospital Stay

Admission to SSC.

You will be admitted on the morning of the surgery. Mr. Vioreanu Personal Assisstant will inform you of the exact time and place to go for your admission.
Do not forget to bring all your relevant imaging studies (Xray’s , MRI’s etc.) and relevant medical letters and tests.

Immediately after surgery.

You will wake up in the recovery ward and will have a bandage on the operated knee. As Mr. Vioreanu uses locally targeted pain control you will find there will be little or no knee pain. A nurse will be with you administering oral pain-killers if necessary. Mr. Vioreanu will come and discuss the surgery performed and will ensure all instructions for the post-operative period are clear. A physiotherapist will visit you and will help you getting out of bed and walk with the assistance of crutches. If you would prefer to stay in the hospital one night after your surgery please let us know in advance so a bed will be booked for you in SSC. When you feel ready to go home, make sure that before leaving SSC hospital you have the prescription for the pain-killers and the post-operative instructions including a date for the follow-up appointment with Mr. Vioreanu. 

After Surgery

Day 1

Please see your local Physiotherapist and follow her instructions for gentle mobilization.
Mr. Vioreanu will phone you to ensure you are comfortable and to answer any questions you may have regarding the immediate post-operative care at home.

The next few days.

If you have any concerns about your post-operative recovery please do not hesitate to contact our office. Mr. Vioreanu will call you back at a suitable time to discuss all your concerns.

Swelling.

The swelling in your knee will reduce progressively over the first 4-6 weeks following surgery.
To facilitate this we advise to place 2-3 pillows under your bed mattress to keep the leg elevated at night time.

Bruising.

Bruising of the lower leg, calf and sometimes the thigh is not uncommon after ACL Reconstruction. It will take one or two weeks to resolve.

Crutches.

You should discard crutches a few days after surgery when walking comfortably if not advised otherwise by Mr. Vioreanu.

Driving.

Driving an automatic car is possible as soon as pain allows after LEFT knee surgery.
Should the RIGHT knee be involved driving is permitted when you are able to walk without crutches and off medication.

Return to work.

Sedentary and office workers may return to work approximately 2-5 days following surgery. On return to the office ensure you elevate and ice the operated leg during day time also.

Travel.

You can travel domestically after 1 week and internationally after 4 weeks. Please discuss it with Mr. Vioreanu at your first follow-up appointment.

Exercise & Return to Sport.

Please print our specific Pre- and Re-habilitation program and bring it to your local Physitherapist. They will follow our recommended program before and after surgery. 

Playing sport non-competitively or training is possible at 6 months. A return to competitive sport is permitted at 9-12 months following surgery, provided that there has been a complete rehabilitation (including the PEP program). These sports should be discussed with Mr. Vioreanu to establish a reasonable time frame for them to occur.
Follow-up Appointments

Mr. Vioreanu will see you 5-7 days after ACL reconstruction for a wound check. The following appointments will be at 6-8 weeks, 6 months and 9-12 months after surgery respectively. You will need to contact our office to make these appointments. You do not need a referral letter for these appointments. You will be charged only a small fee for follow-up appointments.


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