ACL Reconstruction

WHAT IS ACL RECONSTRUCTION?

If you tear the anterior cruciate ligament (ACL) in your knee, you may need to have reconstructive surgery.

The ACL is a tough band of tissue joining the thigh bone to the shin bone at the knee joint.

It runs diagonally through the inside of the knee and gives the knee joint stability. It also helps to control the back-and-forth movement of the lower leg.

 

ACL INJURY

Knee injuries can occur during sports such as skiing, tennis, squash, football and rugby. ACL injuries are one of the most common types of knee injuries.

You can tear your ACL if your lower leg extends forwards too much. It can also be torn if your knee and lower leg are twisted.

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Common causes of an ACL injury include:

• landing incorrectly from a jump

• stopping suddenly

• changing direction suddenly

• having a collision, such as during a football tackle

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If the ACL is torn, your knee may become very unstable and lose its full range of movement.

This can make it difficult to perform certain movements, such as turning on the spot. Some sports may be impossible to play.

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SYMPTOMS OF ACL INJURY

• A “pop” in the knee at the time of injury

• Swelling of the knee

• Inability to bear weight on leg (though some have little or no pain)

• Instability of the knee

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DIAGNOSIS OF ARTHRITIS

Diagnosis is made by evaluating your injury history and symptoms, performing a physical examination and taking an MRI scan of the knee. 

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ACL RECONSTRUCTION PROCEDURE

A number of different tissues can be used to replace your ACL. Tissue taken from your own body is called an autograft. Tissue taken from a donor is called an allograft.

A donor is someone who has given permission for parts of their body to be used after they die by someone who needs them. 

Before your operation, your surgeon will discuss the best option with you.

Tissues that could be used to replace your ACL include: 

• a strip of your patellar tendon – this is the tendon running from the bottom of the kneecap (patella) to the top of the shin bone (tibia) at the front of your knee

• part of your hamstring tendons – these run from the back of your knee on the inner side, all the way up to your thigh

• part of your quadriceps tendon – this is the tendon that attaches the patella to the quadriceps muscle, which is the large muscle on the front of your thigh

• an allograft (donor tissue) – this could be the patellar tendon or Achilles tendon (the tendon that attaches the back of the heel to the calf muscle) from a donor

• a synthetic (artificial) graft – this is a tubular structure designed to replace a torn ligament

 

The most commonly-used autograft tissues are the patellar tendon and the hamstring tendons. Both have been found to be equally successful.

Allograft tissue may be the preferred option for people who are not going to be playing high-demand sports, such as basketball or football, as these tendons are slightly weaker.

Synthetic tissues are currently used in certain situations, such as revision surgery and multi-ligament injuries.

The graft tissue will be removed and cut to the correct size. It will then be positioned in the knee and fixed to the thigh bone (femur) and shin bone (tibia).

This is usually carried out using a technique called knee arthroscopy.

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POSTOPERATIVE CARE FOLLOWING ACL RECONSTRUCTION

Your surgeon or physiotherapist can advise you about a structured rehabilitation programme. It's very important that you follow the programme, so your recovery is as successful as possible.

You'll be given exercises you can start in hospital after your surgery and continue when you get home.

The exercises will include movements to bend, straighten and raise your leg. Ask if you're unsure about how to do any of the exercises.

You'll also be given crutches to help you move around. You may need to use them for about 2 weeks, but you should only put as much weight on your injured leg as you feel comfortable with.

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RISKS AND COMPLICATIONS OF ACL RECONSTRUCTION

As with all types of surgery, there are some risks associated with knee surgery.

They include:

• infection – the risk of infection is small: you may be given an antibiotic after your operation to prevent infection developing

• blood clot – the risk of a blood clot (embolism) forming and causing problems is very low: if you're thought to be at risk, you may be given medication to prevent blood clots forming

• knee pain – affects some people who have ACL surgery and is more likely to occur when the patellar tendon is used as graft tissue; you may have pain behind your kneecap or when kneeling down or crouching

• knee weakness and stiffness – some people experience long-term weakness or stiffness in their knee

After ACL surgery, there's also a small chance that the newly-grafted ligament will fail and your knee will still be unstable.