One of the most common knee injuries is an anterior cruciate ligament or ACL tear.
Athletes who participate in high demand sports with pivoting movements such as soccer, rugby and basketball are more likely to injure their ACLs.
If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee.
Clinical Assessment for ACL Tear
Physical Examination and Patient History
The common symptoms of an ACL tear include pain, swelling and instability of the knee. We will examine your knee and order an MRI scan to confirm the diagnosis and to look for associated injuries such as a meniscal tear.
Conservative Treatment for ACL Tear
Conservative treatment is usually reserved for older and inactive patients.
Bracing A brace may be required to provide stability. In the initial few weeks of the injury, a pair of crutches might be required to offload the affected knee.
Physical therapy is another option. When the swelling starts to disappear, various exercises can help to strengthen the muscles that support the knee.
Surgical Treatment for ACL Tear
Surgery is not as simple as stitching the torn ligament back together. It requires a complete reconstruction of the ligament. This is usually done as a day surgery procedure.
During the surgery, the torn ACL is replaced with a tissue graft that acts as a scaffold on which a new ligament will grow on. The graft is usually taken from your own body and the common sources of this graft would be the hamstring or the patella tendons.
Dr Kevin Lee’s preference is the use of the hamstring tendons. All graft sources have pros and cons. It is important to discuss the choices thoroughly with your orthopedic surgeon to determine which one is the best for you.
Surgical Procedure for ACL Tear
Dr Lee’s preference for anaesthesia in this surgery is a general anaesthetic with a femoral nerve block to reduce post-operative pain.The patient is usually sent to physical therapy before any surgical treatment. At the time of ACL reconstruction surgery, patients who have a stiff and swollen knee lacking full range of motion may have significant problems regaining motion after surgery. To achieve full range of motion, it usually takes about 2 weeks from the time of injury. Prior to surgery, patients are usually put on a brace to stabilise the knee and prevent further damage to the knee.
The surgeon places an arthroscope into the joint after the graft has been prepared. The surgeon examines the condition of the knee by making one-centimeter incisions called portals in the front of the knee to insert the arthroscope and instruments. Meniscus tears and cartilage injuries are trimmed or repaired and the torn ACL stump is then removed.
Bone tunnels are drilled into the tibia and the femur to place the ACL graft in the same position as the torn ACL.
Bone Tunnels Created
A long needle is passing through the tunnel of the tibia, up through the femoral tunnel, and then out through the skin of the thigh. The sutures of the graft are placed through the eye of the needle and the graft is then pulled up into the femoral tunnel with the sutures.
Sutures Pulled Through Tunnels
The graft is held under tension as it is fixed in place using interference screws, spiked washers, posts, or staples. These devices used to hold the graft in place are generally not removed.
New Reconstructed ACL
Dr Lee will conduct variations to this surgical technique, including the “over-the-top”,”two-incision,” and “double-bundle” types of ACL reconstructions in special circumstances such as revision (redo) ACL reconstruction and open growth plates.
The patient usually goes home on the same day of the surgery.
Rehabilitation after ACL Reconstruction
Physical therapy plays an important role in the success of this surgery and exercises begin soon after the acl reconstruction surgery. With new surgical techniques and stronger graft fixation, current physical therapy programmes use an accelerated course of rehabilitation.
- The wound is kept clean and dry, and early emphasis is placed on regaining the ability to fully straighten the knee and restore quadriceps control in the first 10 to 14 days after surgery,
- The knee is iced regularly to reduce swelling and pain. Dr Lee’s patients are put on a brace for the first 2 weeks. Weight-bearing status (use of crutches to keep some or all of the patient’s weight off of the surgical leg) is determined by other injuries addressed at the time of surgery.
- By about 3 months, you should be able to swim, bike and start jogging.
- The return to high demand sports such as soccer and basketball usually takes at least 9-12 months. The use of a functional brace when returning to sports is not needed after a successful ACL reconstruction, but some patients feel a greater sense of security wearing one.