Arthroscopic Anterior Cruciate Ligament Reconstruction (ACL)

ACL – Description

The ACL is well recognised as a key structure in providing stability in the knee. The most common cause of ACL rupture is a traumatic force being applied to the knee in a twisting moment. This can occur with either a direct or an indirect force.

In my practice, about half of the cases of ACL rupture occur without contact, e.g. whilst side stepping, pivoting, or landing from a jump, the other half can result from direct contact e.g. football, rugby, and skiing. Diagnosis can be confirmed with an MRI scan.

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  • Treatment Options
  • Recovery
  • Considerations
The ACL Reconstruction

The ACL Reconstruction

The operation can be done under either general or spinal anaesthetic, it takes between an hour and an hour and a half. The ACL reconstruction can be done with several different graft choices. These include hamstring tendons (from behind the knee), patellar tendon (in front of the knee), or donor tissue (allograft).

The operation is usually performed using arthroscopic (key hole) surgery. There is however either a 1.5 inch incision just below the knee (hamstring graft), or 3 inch incision in front of the knee (patellar tendon graft).

Are there any alternatives to surgery?

Operation is not required for all ACL injuries. A small number of patients with lower physical activity levels who do not participate in twisting activities can be treated conservatively with a well supervised physiotherapy programme.

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Rehabilitation

Rehabilitation

You will undergo an intensive supervised physiotherapy programme in which you have to take an active role.

Patients can go home the day after operation, and can drive a car two weeks after surgery provided your surgeon is happy with your progress.

You can go back to an office job 2 weeks after operation but that can take longer if you are in a manual job.

What about returning to sports?

An elite athlete who has a technically well performed early reconstruction of the ACL followed by a successful rehabilitation programme should be able to return to the field of his chosen sport between 6 – 9 months.

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Complications

Complications

Complications include infection, numb patch of skin over a small area but rarely a problem, stiffness (uncommon), deep vein thrombosis (DVT), and failure of the graft due to re injury or stretching. However the success rate of ACL is over 95%.

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