Anterior cruciate ligament reconstruction has become a very common and very successful procedure over the last 2 decades. Before the 1980’s a cruciate ligament injury meant an end to sport and to significant physical activity. The ACL is essential for pivoting activity such as is necessary to play football, netball or soccer. Fortunately the work of some pioneering Orthopaedic Surgeons has made ACL reconstruction a very reliable and successful procedure.
Anterior cruciate ligament rupture is a devastating injury for a sports person. The knee becomes painful, swollen and unstable.
Mr Donohue assesses knee injuries by taking a thorough history and performing a physical examination. Xrays may be useful. An MRI scan is often performed to confirm an ACL injury and to look for other knee injuries – this may involve meniscal tears, other ligament injuries or injury to the knee joint surface. Most young, active, and healthy patients who rupture their ACL come to ACL reconstruction.
The surgery involves an arthroscopy which is a telescopic keyhole examination of the knee joint. The diagnosis is confirmed. The ACL rupture is then replaced with a graft. In most cases this involves a graft from the patient’s own hamstrings tendons. The patella tendon can also be used. The graft is placed through tunnels in the bone at the tibia and the femur, and is fixed into place using screws or a device called an Endobutton. Allograft (donor tissue) may also be used as a graft.
Any meniscal pathology is dealt with at the time. Joint injuries may sometimes have to be repaired.
Generally the operation needs an overnight stay in hospital, but the patient returns home the next day with crutches for support.
ACL reconstructive surgery is a very successful procedure, but the recovery is prolonged. Traditional teaching has a return to full contact sport at 12 months. With a patella tendon graft this return to sport may be reduced to 6 months. Physiotherapy is an important part of the recovery process.
Since 2006 Mr Donohue have had experience with the LARS ligament which is a synthetic polyester scaffold developed in France. He has used this for patients who desire an early return to sport, or indeed to work. The advantages of this graft are that he does not need to take anything from the patient to use as a graft. What is left of the ACL is retained. The synthetic ligament is then placed through bony tunnels and fixed with titanium screws. This requires an overnight stay in hospital and a return home the following day. Because of the lack of concerns about weakening of the graft, rehabilitation is quicker than normal. A return to sporting activities may be possible within 3 months.
ACL reconstruction is generally a very successful procedure. However, as with all operations complications can occur. This may involve things such as infection, bleeding or blood clots (thrombosis). Nerve or vascular injury can rarely occur. Ongoing pain or numbness is possible. Unfortunately not all patients are able to return to their previous activity level.
The ACL reconstruction can fail in the early or late recovery period. The graft can rupture or loosen. Revision surgery can then be necessary. Synovitis has been reported following LARS surgery.
Despite all these risks the vast majority of patients are happy with the results of ACL reconstruction and after 12 months most can return to their chosen sport or activity.
Mr Donohue generally reviews patients 2 weeks following ACL reconstruction at which stage a physiotherapy/rehab program is begun.
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