Anterior Cruciate Ligament (ACL) Reconstruction
The classic history usually involves a pivoting or deceleration manoeuvre, there is collapse to the ground and sometimes a sound is heard, or a pop is felt. Swelling occurs characteristically within a few hours. This means there is bleeding into the joint. After this injury the player almost always has to be carried off the court or sporting ground. It is common to end up in an Emergency Department and have an x-ray and be told ‘there is no fracture’.
The knee often improves within a couple of weeks. Return to sport may be associated with repeated instability episodes.
Who can benefit?
For all younger active patients surgery should be considered and is usually recommended. This is to restore stability to the knee and prevent injury to the menisci which can lead to degeneration of the joint. Older patients with an ACL tear may choose to avoid surgery, but in that case should not return to pivoting ball sports.
Running, cycling, swimming, driving, and working, are usually possible without an ACL.
How is the surgery done?
The torn ACL remnant is removed and cartilage tears dealt with. A graft is harvested and then inserted through drill holes re-creating the normal position of the ACL.
The graft is held securely with screws or special buttons.
For the majority of cases, Mr Gohil uses hamstring grafts since the cuts required to perform this surgery are significantly smaller than using the central third of the patella tendon. A small cut of 3–4 cm is made over the upper leg to remove the hamstring grafts.
Post operation rehabilitation
Early physiotherapy and accelerated rehabilitation are associated with better outcomes, and we rarely recommend a post-op brace. Our anaesthetists help achieve minimal post-op pain and the techniques used by our surgeons also streamline the operation and allow quick surgery with small incisions and faster recovery.
Rehabilitation involves seeing a physiotherapist. Results are optimal with: early regaining of normal gait pattern, full weight bearing; moving onto functional activities such as cycling and swimming within the first 6 weeks, and jogging within two to four months. Weight training is allowed after several months.
Return to sport
What are the risks?
ACL reconstruction is a very successful operation with a low complication and high success rate. It is possible to have numbness over the outside aspect of the knee. Stiffness of the knee and blood clots are possible but usually avoided by accelerated rehabilitation and early weight bearing.
Infection is always possible but is rare. Graft re-rupture is possible when returning to high level sports for years into the future, but tends to approximate the risk of rupture of the normal ACL of the other knee.
Overall the re-rupture rate is relatively rare in our hands.
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