ACL reconstruction surgery
Injury to the anterior cruciate ligament (ACL) is a significant setback, particularly for athletes and active individuals. Commonly seen in sports like skiing, football and rugby, an ACL injury often occurs suddenly, marked by a knee collapse, an audible pop, and rapid swelling accompanied by pain.
The ACL is crucial for maintaining knee stability and preventing abnormal movements that can damage the cartilage over time. When untreated, the instability caused by a torn ACL can lead to chronic issues, including further injury and long-term joint damage.
While ACL injuries are common among athletes, they can happen to anyone and require timely and appropriate intervention. Fortunately, a variety of treatments are available to restore stability, function, and confidence.
Overview
Knee injuries are common in both amateur and professional sports. Recently, the treatment of sports injuries has improved significantly. The ACL is responsible for detecting and assisting the rotation of the knee, providing information to the brain and muscles about its position. Around 50% of ACL injuries result in damage to the joint cartilage or other knee ligaments.
Besides pain and instability, ACL injuries can worsen every time the knee gives way. This can lead to arthritis. Half of those who experience an ACL injury may develop osteoarthritis later in life. Although the benefits of ACL reconstruction for reducing arthritis risk are unclear, early ACL reconstruction can prevent damage to the meniscus (knee shock absorber). It is not recommended to return to sports activities without proper assessment, as it can aggravate the situation.
Causes
Sports such as football (soccer), skiing, netball and basketball carry a high risk of ACL injury. These injuries can happen during sports activities or even in the workplace. Most ACL injuries occur in non-contact sports, with only 30% of cases attributed to contact with another player. High-risk moves like sidestepping and sudden changes of direction can cause excessive knee rotation, leading to ACL tears. This is because the ACL is one of the few restraints that prevent over-rotation of the knee. Any of the anatomic elements that control over-rotation can be damaged, including the menisci, bone, joint capsule, collateral ligaments, and in severe cases, the posterior cruciate ligament.
Symptoms
Experiencing trouble with controlling knee rotation is a common sign, usually occurring when turning while walking or running. In such situations, your knee may give out or collapse. Additionally, other symptoms like locking, clicking, and popping of the knee could be due to related injuries. If other structures or anatomic elements like the menisci (shock absorber) are harmed, then the pain you feel could indicate damage.
Diagnostics
To diagnose an ACL injury, doctors typically examine the patient’s medical history, conduct a knee examination, and perform an MRI scan. It’s important to provide details about how the injury occurred, such as a side step, tackle, fall, or similar incident that may have caused pain and swelling and possibly a popping sound.
By gently moving the tibia and femur with their hands, doctors can confirm damage to the ACL when there’s an increase in forward movement of the tibia in relation to the femur. Standard X-rays are usually not helpful in detecting ACL injuries.
At Cabot Clinic, we have access to advanced MRI scanners that can provide detailed images of the knee’s ligaments and cartilage, allowing for a faster and more accurate diagnosis for treatment.
Treatments
There are various ways to treat a damaged ACL, one of which is through keyhole surgery. The damaged ACL is replaced with an ACL grafted tendon, with different types of grafts available to match the specific situation. These include:
- Auto-graft (using patient’s tendon) — the most frequently used procedure
- Allograft (another person’s tendon) — particularly when several ligaments need to be reconstructed
- Synthetic (artificial) — used on occasion to reinforce a graft or as an alternative
- Xenograft (animal tendon) — not used in practice
Of these options, an autograft is typically the most commonly used procedure. The surgeon will consider various factors, including strength, when selecting which tendon to use for the autograft.
The Cabot Clinic has extensive experience treating both amateur and professional athletes in several countries, including the UK, Australia, Canada, and India. Our surgeons will be happy to discuss which technique is best suited for your knee and individual needs.
Recovery
It is essential to undergo physical therapy as part of post-surgery rehabilitation to ensure a successful recovery. Although a patient may be able to stand and walk on the same day as the surgery, it will take time to fully rehabilitate the muscles and the brain’s coordination of the knee. At Cabot Clinic, we offer a physical therapy program to assist patients during this period.
Rehabilitation can be divided into the following phases:
- Phase 1 — prehabilitation, before surgery
- Phase 2 — early post-operative phase
- Phase 3 — coordination and proprioception (sensory awareness)
- Phase 4 — muscle strengthening phase
- Phase 5 — reinjury avoidance training
- Phase 6 — return to play
Typically, a patient can resume running (initially straight line) within three months. However, sports that involve rotational or side-stepping movements, such as rugby, football, netball, and skiing, may require up to nine months to resume.
References
Have you experienced a pop, sudden severe pain, rapid swelling, or knee instability?
If you suspect an ACL injury, early diagnosis and treatment are crucial to avoid long-term knee damage. Book a consultation with our expert surgeons now.