ACL Reconstruction

Anterior Cruciate Ligament (ACL) Reconstruction

ACL Reconstruction Patellar Tendon

ACL Reconstruction Hamstring Method

What is the ACL?

The anterior cruciate ligament (ACL) is a ligament in the middle of the knee that is very important in providing stability to the knee, especially in twisting movements.

How is it ruptured?

The ACL is often ruptured during a pivoting or twisting movement, usually while playing sport. It can also be caused by a blow to the outside of the knee when the knee is bent. Sometimes, it is caused by hyper-extending (over straightening) the knee, such as when jumping up and landing awkwardly.

What problems does an ACL rupture cause?

When the ACL ruptures, there is often sudden pain and the knee gives way. The knee typically swells significantly. The pain and swelling typically take a few weeks to resolve. The main problem that an ACL rupture causes is instability of the knee. If you are lucky, the ACL may heal well enough that it does not cause significant problems, especially if you do not play sport. Often, however, the knee may feel unstable or give way with twisting movements during sport or, in the worst cases, even when doing day to day activities.

Long term, if the knee is unstable, there is an increased risk of further injury to the cartilage within the knee and also arthritis.

How is an ACL rupture treated?

Immediately after a significant knee injury like an ACL rupture, applying ice to the knee is important, as it minimises swelling. Resting and elevation are helpful and a period mobilising with crutches may be necessary.

Early review by an Orthopaedic Surgeon is recommended so that the knee can be assessed. Sometimes there may be other ligament or cartilage injuries that may also be present. An MRI scan is helpful in confirming the extent of the injuries. Physiotherapy should be commenced as early as possible to reduce swelling and regain muscle strength and range of motion at the knee.

Depending on your circumstances and the stability of the knee, the ACL rupture may be treated surgically or non-surgically. Non-surgical treatment involves rehabilitating the knee and gradually returning to full activities. If you are able to return to all of your normal activities and the knee does not feel unstable, no further treatment is necessary. If the knee is unstable or you wish to return to sports that involve a lot of twisting and pivoting or contact sports, non-surgical treatment is less likely to be successful. In that case, an ACL reconstruction is recommended.

What is an ACL reconstruction?

An ACL reconstruction involves using a graft to replace the ACL. There are several options available in terms of choosing a graft. The most common graft is created from two of the hamstring tendons from the back of the thigh. A small incision about 4cm long is made in the front of the knee through which the two tendons are taken. They are then doubled over and stitched together to form the new ACL. Two small portals (less than 1cm long) are made in the front of the knee to perform an arthroscopy. Any other injuries in the knee can be managed through these portals. Tunnels are drilled through the femur (thigh bone) and tibia (shin bone). The graft is then pulled up into the tunnels so that it lies in the position of the original ACL. The graft is fixed in place with buttons or screws. The wounds are then closed.

Current research shows that the success of the ACL reconstruction depends on the positioning of the tunnels. The surgeons at Melbourne Hip and Knee have trained with several world leaders in ACL surgery in Australia, Europe and North America, to learn the most advanced techniques in ACL reconstruction, giving you the best chance of regaining stability in your knee.

How long does is the recovery after an ACL reconstruction?

After an ACL reconstruction, you are encouraged to begin bending and straightening it immediately. You will be able to be discharged from hospital the morning after your operation. You will be able to walk on the operated leg but will need crutches for 1-2 weeks.

The amount of time you will need to take off work depends on the type of work you do. For desk-based jobs, you will need 2 weeks off. If your job involves heavy manual labour, you may require 2-3 months of leave. The rehabilitation after an ACL reconstruction occurs over a long time. It will take 3-4 months before you can cycle or jog and it can take 9-12 months to return to sport. It is important not to try to get ahead of the rehabilitation program as this may cause the graft to stretch out or rupture.