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ACL injury (rupture)

ACL injury (rupture): treatment & surgery

Depending on the grade, not all ACL injuries require 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. If the knee is deemed unstable, surgical reconstruction of the ACL is recommended. Essentially, achieving rotational stability prevents further damage to the meniscus and cartilage surface within the knee.

Treatment of ACL tear without surgery

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 “Prehab” the patient 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.

Conservative treatment methods

  • Treatment of ACL tear without surgery

Minimally invasive ACL reconstruction surgery

ACL reconstruction surgery is achieved using a minimally invasive arthroscopic procedure. As arthroscopies only require very small incisions, through which an arthroscope (a tiny camera) is inserted into the knee, the trauma of access can be minimised.

With direct visualisation through the arthroscope, the surgeon uses specifically designed surgical instruments to reconstruct the ligament. Minimally invasive procedures cause very little disruption of the surrounding tissues, which aids a quicker recovery and minimal scarring. Like most surgical procedures, there are many ways of achieving an excellent ACL reconstruction. However, surgeons across the world tend to use this technique to restore the ACL by replacing the torn ligament with a soft tissue graft. But the choices of graft material varies widely across the world. 

Your surgeon will discuss your surgical options available in terms of reconstruction and what they feel is the best technique in your specific case. The following will be considered carefully:

  1. The type of graft that can be used; such as your own tissue, hamstring, patellar tendon graft (autograft) and/or the use of donated Cadaveric tissue (allograft).
  2. The type of reconstruction, for example, isolated ACL reconstruction and/or the need for extra-articular support with lateral tenodesis (particularly in the revision situation).
  3. The fixation methods used to hold the graft, both in the thigh bone and the shin bone.
  4. ACL reconstruction involves undergoing a general anaesthetic and is now done often as a day case procedure. The operation takes approximately forty to sixty minutes depending on what other additional surgery is required at the same time.

The procedure involves drilling bony tunnels in 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 "scaffolding" on which the new ligament can grow by a very gradual process of substitution. This is a biological process that takes considerable time, although the artificial graft produces a degree of instant stability, albeit not adequate for immediately sporting activity.

Surgical treatment methods

  • Minimally invasive ACL reconstruction surgery