ACL Reconstruction

Background

The anterior cruciate ligament (ACL) is an important stabiliser of your knee is usually injured as an acute injury which can involve side stepping, jumping and twisting or from a direct blow in a tackle. Patients commonly describe hearing a “pop” or “crack” and the knee usually swells within 24 hours. You may not be able to walk or fully straighten the knee after injury. The knee will often take a few weeks to feel better only to then become unreliable once you return to sport. MRI scan will usually reveal the diagnosis and detect other possible injuries.

Indications

Reconstruction of the ACL is necessary to restore stability to the knee and help reduce the risk of further damage to the cartilage and meniscus and prevent early onset osteoarthritis. Dr Anderson will discuss the possible treatment options with you on the day of consultation.

Treatment/Pathology

ACL injuries will most commonly require ligament reconstruction however occasionally it may be possible to directly re-attach the ligament to bone. Often you will have already seen a physiotherapist before seeing Dr Anderson and it is usually beneficial to have pre-operative rehabilitation (“Prehab”) to minimise the amount of muscle wasting that can occur before surgery. 

Dr Anderson will talk to you about your injury and history and then perform an examination of your knee. He will then look at your imaging (MRI) with you. In most circumstances we are able to access the images via electronic means however you should still bring the hard copy films along if you have them. 

Surgical Detail

Reconstruction of the ACL is done via arthroscopic (“key-hole”) technique utilising current well proven methods.  The most common graft donor site is the hamstrings at the back of the thigh - other graft options are potentially available and these can be discussed at the time of consultation. Additional procedures can also be performed at the same time to treat associated conditions (e.g. meniscal tears). The surgery is performed under a general anaesthetic and you will stay in hospital overnight to rest and recover. Dr Anderson and a physiotherapist will see you the following day to discuss the surgery and get you mobile on crutches for the first 2 weeks.

Post-Operative/Recovery

You will see Dr Anderson 2 weeks after surgery where he will check your wounds and remove the brace if appropriate. It's a good idea to make an appointment with your physiotherapist to be seen shortly after this visit (i.e. next 1-2 days). It is important to follow the prescribed ACL rehabilitation program under the supervision of your physiotherapist to reduce the risk of re-injury. You will see Dr Anderson regularly over the next 9-12 months as he monitors your progress through the dedicated rehabilitation phases.

 Key Points

• Acute injury

• Usually requires reconstruction

• Excellent results for return to sport