ACL Treatment & Surgery
Not all ACL injuries need reconstructive surgery. In some cases, the ACL can re-attach to surrounding structures and render the knee stable after a few weeks (approximately 10% of cases).
It may be possible to pursue many sports without a functioning cruciate ligament. However, more rigorous, high-demand sports that involve a lot of “cutting”, twisting and pivoting are much more dependent on an intact, functioning ACL.
For most patients, the initial treatment centres around reducing the swelling within the knee whilst strengthening the muscles around the knee to act as secondary supports for stability.
A specialist physiotherapist will often “Pre-hab” the parent so as to help reduce swelling, improve movement in the knee and let the soft tissue injury settle whilst optimising early recovery.
If a second ligament (eg. MCL) is injured, you may need the knee braced for a few weeks until this heals, and this can slow the recovery down a little.
The stability of the knee is often assessed carefully once you have a pain free range of movement and if the knee is deemed unstable, a surgical reconstruction of the ACL is recommended. Essentially, achieving rotational stability prevents further damage to the meniscus and cartilage surface within the knee.
ACL reconstruction surgery
Due to advances in surgical techniques, what was once a major open operation is now a minimally invasive procedure, meaning it has become an increasingly popular operation over the last decade.
Like most surgical procedures, there are many ways of achieving an excellent ACL reconstruction. Most surgeons across the world use a similar technique to restore a ‘new’ ACL, but the choice of graft material varies widely.
Your surgeon will discuss with you the surgical options available in terms of reconstruction and what they feel is the best technique in your individual case. The following will be considered carefully:
- The type of graft that can be used - such as your own tissue, hamstrings or patella tendon graft (autograft) or the use of donated cadaveric tissue (allograft).
- The type of reconstruction ie isolated ACL reconstruction and/or the need for extra articular support with lateral tenodesis (particularly in the revision situation).
- The fixation methods used to hold the graft .
- ACL reconstruction involves undergoing a general anaesthetic and is now done as a day case procedure. The operation takes approximately 40-60 minutes.
The operation is carried out under direct vision of the arthroscope (camera) inserted within the knee. Bony tunnels are drilled within the shin bone (tibia) and the thigh bone (femur) to allow the graft to be pulled across and held in place securely. This graft is, in effect, creating a ‘scaffold’ on which a new ligament can grow.