Anterior Cruciate Ligament (ACL) Reconstruction
The ACL is mainly injured during sports involving jumping, turning and side stepping. Skiing and ball sports are commonly associated with ACL injury. Patients frequently hear or feel a snap within the knee and are unable to continue their activity, the injury is usually associated with rapid swelling of the knee, initially eased by rest, ice and compression. As the swelling settles however, pain or instability, particularly on turning may be noted.
ACL injury is difficult to avoid due to it’s occurrence during sporting activities, but maintaining fitness and generalised muscle tone around the knee, along with warming up prior to activities will help.
You will be admitted on the day of surgery and discharged either that evening or the following morning. The surgery is performed arthroscopically (keyhole surgery) using hamstring autograft (your own tendons from the same knee). This technique involves a general anaesthetic and local anaesthetic block (extra pain killing anaesthetic placed in the area of the knee to aid rapid recovery).
A full examination and diagnostic arthroscopy are performed and the hamstring graft is harvested, usually two of the hamstrings are taken, preserving the remaining hamstring tendons and muscles to maintain knee function. Tunnels are drilled in the tibia and femur and the tendon grafts are passed across the knee, securely fixing them to reconstruct the torn ACL. You will have the wounds dressed and a bandage placed which will be taken down after 24hours. Physiotherapy will start immediately. You will be on crutches for approximately 7 days (or less if possible) with no brace or immobilisation of the knee.
Conservative treatment mainly involves physiotherapy to strengthen the knee and improve proprioception (the body’s awareness of the position of the knee). This treatment will usually give a stable knee to linear movements (those in a straight line), but instability can still be felt on turning and side stepping. A proportion of patients can get back to competitive sports with this treatment, but most find the knee to be unstable and at risk of further injury. Most sporting patients elect for an ACL reconstruction.
Most patients are off crutches at about a week, walking normally and driving at about 2 weeks. Return to sports can occur gradually, solo sports at about 3 months, non-contact at 6 months and contact sports at 1 year (this will be led by your physio team)