ACL Reconstruction

 
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Overview

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 does not 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 ligament 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 usually aware of 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 ACL reconstruction surgery.

History of injury

  • Most injuries are sports related involving a twisting injury to the knee
  • It can occurs with a sudden change of direction, a direct blow e.g., a tackle, landing awkwardly
  • Often there is a popping sound when the ligament ruptures
  • Swelling usually occurs within hours
  • There is often the feeling of the knee popping out of joint
  • It is rare to be able to continue playing sport with the initial injury

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.

It is strongly advised to give up sports involving twisting activities, if you have an ACL injury as episodes of instability can cause further damage to important structures within the knee that may result in early arthritis.

Indications for surgery

  • Young patients wishing to maintain an active lifestyle.
  • Sports involving twisting activities e.g., Soccer, netball, football
  • Giving way with activities of daily living.
  • People with dangerous occupations e.g., Policemen, firemen, roofers, scaffoulders.

It is advisable to have physiotherapy prior to ACL reconstruction surgery to regain full motion and strengthen the muscles as much as possible.

Surgery

Surgical techniques have improved significantly over the last decade. 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 or the patella tendon.

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 are then closed often with a drain and a dressing applied.

Post operation

  • Surgery is performed as an overnight stay.
  • You will have pain medication.
  • Any drains will be removed from the knee the morning after the surgery.
  • An xray is done prior to leaving the hospitakl to check the poistion of the implants.
  • A splint is sometimes used for comfort.
  • You will be seen by a physiotherapist 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 review.
  • Dr Klar will advise you after the operation how much weight to put on the leg.
  • Put ice on the knee for 20 minutes at a time, as frequently as possible.
  • Post-op review will usually be at 12-14 days.
  • Physiotherapy can begin after a few days or can be arranged at your first post-op visit.

Risks and complications

As with any major surgery, possible risks and complications exist and those associated with total knee replacement surgery include:

  • Knee stiffness or arthrofibrosis
  • Infection in the artificial knee joint
  • Blood clots (deep vein thrombosis) or lung clots
  • Graft failure
  • Nerve and blood vessel damage
  • Ligament injuries
  • Patella (kneecap) dislocation or fracture
  • Plastic liner wearing out
  • Ongoing pain of uncertain origin in up to 10% of patients
  • Loosening of the implants
  • Unsightly or thickened scar
  • Complex regional pain syndrome
  • Hardware issues

Rehabilitation

Physiotherapy is an integral part of the treatment and is recommended to start as early as possible. Preoperative physiotherapy 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 physiotherapist 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 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.

Make an Appointment

Make an appointment online for a consultation at
Canberra Knee Clinic.

Not in Canberra? Call us to book your appointment at
our Goulburn or Moruya clinic.

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