Find out more about ACL Reconstruction Hamstring Tendon with the following link
Find out more about ACL Reconstruction Patellar Tendon with the following link
The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope like structure located in the centre of the knee running from the femur to the tibia.
When this ligament tears unfortunately it doesn’t heal and often leads to the feeling of instability in the knee.
ACL reconstruction is a commonly performed surgical procedure and with recent advances in arthroscopic surgery can now be performed with minimal incisions and low complication rates.
The ACL is the major stabilizing ligaments in the knee. It prevents the tibia (Shin bone) moving abnormally on the femur (thigh bone). When this abnormal movement occurs it is referred to as instability and the patient is aware this abnormal movement.
Often other structures such as the meniscus, the articular cartilage (lining the joint) or other ligaments can also be damaged at the same time as a cruciate injury & these may need to be addressed at the time of surgery.
Once the initial injury settles down the main symptom is instability or giving away of the knee. This usually occurs with running activities but can occur on simple walking or other activities of daily living.
The diagnoses can often be made on the history alone.
Examination reveals instability of the knee, if adequately relaxed or not too painful.
An MRI (Magnetic Resonance Imaging) can be helpful if there is doubt as well as to look for damage to other structures within the knee.
At times the final diagnoses can only be made under anaesthetic or with an Arthroscopy.
Not everyone needs surgery. Some people can compensate for the injured ligament with strengthening exercises or a brace.
Young patients wishing to maintain an active lifestyle.
Sports involving twisting activities such as soccer and football.
Giving way with activities of daily living.
People with dangerous occupations e.g., Policemen, firemen, roofers.
It is advisable to have physical therapy prior to surgery to regain motion and strengthen the muscles as much as possible.
Surgical techniques have improved significantly over the last decade, complications are reduced and recovery much quicker than in the past.
The surgery is performed arthroscopically. The ruptured ligament is removed and then tunnels (holes) in the bone are drilled to accept the new graft. This graft which replaces your old ACL is taken either from the hamstring tendon, the patella tendon or allograft. There are advantages & disadvantages of each with the final decision based on surgeons preference.
The graft is prepared to take the form of a new tendon and passed through the drill holes in the bone.
The new tendon is then fixed into the bone with various devices to hold it into place while the ligament heals into the bone (usually 6 months).
The rest of the knee can be clearly visualized at the same time and any other damage is dealt with e.g., meniscal tears.
The wounds then closed and a dressing applied.
Surgery is performed as a day only procedure.
You will have pain medication by tablet or in a drip (Intravenous).
A splint is sometimes used for comfort.
You will be seen by a physical therapist who will teach you to use crutches and show you some simple exercises to do at home.
Leave any waterproof dressings on your knee until your post-op visit.
Put ice on the knee for 20 minutes at a time, as frequently as possible.
Post-op visit will usually be at 8 days.
Physical Therapy can begin after a few days or can be arranged at your first post-op visit.
If you have any redness around the wound or increasing pain in the knee or you have temperature or feel unwell, you should contact your surgeon as soon as possible.
Physical Therapy is an integral part of the treatment and is recommended to start as early as possible. Preoperative physical therapy is helpful to better prepare the knee for surgery. The early aim is to regain range of motion, reduce swelling and achieve full weight bearing.
The remaining rehabilitation will be supervised by a physical therapist and will involve activities such as exercise bike riding, swimming, proprioceptive exercises and muscle strengthening. Cycling can begin at 2 months, jogging can generally begin at around 3 months. The graft is strong enough to allow sport at around 6 months however other factors come into play such as confidence, fitness and adequate fitness and training.
Professional atheletes often return at 6 months but recreational athletes may take 10 -12 months depending on motivation and time put into rehabilitation.
The rehabilitation and overall success of the procedure can be affected by associated injuries to the knee such as damage to meniscus, articular cartilage or other ligaments.
The following is a more detailed rehabilitation protocol useful for patients and physical therapists. It is a guide only and must be adjusted on an individual basis taking into account pain, other pathology, work and other social factors.
Acute (0 – 2 Weeks)
Stage 2- Quadriceps Control (2-6 Weeks)
Stage 3- Hamstring/Quadriceps Strengthening (6-12 Weeks)
With respect to hamstring loading, they should never be pushed into pain and should be carefully progressed. Any subtle strain or tightness following exercises should be managed with a reduction in hamstring based exercises
Prior to running certain criteria must be met
Stage Four-Sport Specific (3-6 Months)
Stage Five-Return to Sport (6 Months Plus)
A safe return to sporting activities