ORTHOPAEDIC KNEE SURGEON
The anterior cruciate ligament (ACL) is relatively commonly injured, particularly in sports involving acceleration, deceleration and change of direction. It can be injured during relatively benign events as well.
This anterior cruciate ligament can be partially or completely torn.
Partial tears are rare and conservative treatment can be considered. This involves protecting the cruciate ligament for a period of 3 to 6 months. Together with this, significant physiotherapy and biokinetic rehab is necessary.
In the majority of cases, the anterior cruciate ligament is completely ruptured.
The completely ruptured anterior cruciate ligament can be treated conservatively which involves physiotherapy, biokinetics and rehab. This can sometimes return the patient to full sporting activities with a non-symptomatic knee.
Multiple scientific studies have established that without an anterior cruciate ligament there is increased rotational and anterior-to-posterior instability. This may not produce conscious episodes of instability. However ACL deficient knees show increased damage to the menisci and early onset degenerative osteoarthritis.
The primary goal of ACL reconstruction is to stabilize the knee and delay the onset of osteoarthritis. Thus patients of any age who maintain a relatively active lifestyle regardless of sporting choice may benefit from anterior cruciate ligament reconstruction.
The decision whether or not to have the anterior cruciate ligament reconstructed is a personal choice based on the information available, and discussion with the surgeon.
The State of the Art surgical technique is to create an “ANATOMIC ACL RECONSTRUCTION”. To achieve this position of the reconstructed ligament must be in the anatomic “footprint” of the ruptured ACL. I do this anterior cruciate ligament reconstruction as an arthroscopic or keyhole. The ligament is reconstructed using a substitute graft.
The graft is pulled through the tibia (lower bone) and then the femur (upper bone).
It is then fixed to the femur with an endobutton and to the tibia with an interference screw.
It is typically after 6 to 9 months that a patient is able to return to sport but it can be longer before they regain their top speed and acceleration.