The Anterior Cruciate Ligament (ACL) is one of the main ligament stabilisers of the knee joint that resists:
- The tibia from translating forward of the femur
- Hyperextension of the knee joint
- Varus (bow legged) and valgus (knocked knee) deformity of the knee
- Rotation of the femur on the tibia
The ACL is a commonly injured ligament of the knee. Dr Arora performs arthroscopic assisted ACL reconstruction through mini incisions.
Commonly, the ACL is injured in a non-contact injury where the knee ‘twists’ during foot landing or push-off. The feeling or sound of a “pop” may be experienced, with pain and a rapid joint swelling. The knee may give way when you try to walk, particularly changing directions.
Dr Arora will take a thorough history and examination to help make the diagnosis of an ACL injury.
Plain knee x-rays are essential. Often the surgeon requests an MRI scan to help confirm the diagnosis, and to assess other knee injuries such as bone bruising, meniscal tears and other ligament tears that may require treatment.
As with many orthopaedic injuries, an ACL rupture is not life threatening, and it is not essential for a surgeon to perform a reconstruction. However the concern is that repeated knee injury from an ACL unstable knee, will cause repeated cartilage damage, early progressive arthritis and pain in the knee, necessitating additional intervention by a surgeon.
ACL ruptures can be managed without the assistance of a surgeon if the patient is able to live within their envelope of stability by avoiding sports and movement that reproduce knee instability.
The operative management of ACL rupture is indicated in the individual who is unable to live within the envelope of stability in the injured knee. These individuals generally fall in to two groups:
- Those that are participating at a high level of sport, and have high demands of their knee, where they want to take part in activity and sporting activities that require more stability in the knee where damage would likely occur if the ACL is not reconstructed
- Those that may not participate at a high level of sport, but find that their knee is unstable with activities of daily living and recreational activities.
There are a variety of methods and graft types surgeons use to reconstruct the knee. Dr Arora uses modern arthroscopic ACL reconstruction techniques, and prefers to use the patient’s own hamstring tendons, and where necessary bone-patella tendon-bone graft. Donated graft (Allograft) is also used in select cases where necessary.
Dr Arora has a special interest in hybrid ACL reconstructions – using hamstring tendons from the patient plus a synthetic ligament to accelerate rehabilitation and return to sport. Dr Arora learnt this art while doing a knee arthroscopy fellowship with Dr Peter Annear, one of Australia’s leading knee surgeons.
The specific type of procedures required during your ACL reconstruction will be discussed with your surgeon prior to the procedure. In general for most patients:
- Your anaesthetist will perform general anaesthetic
- Your knee is prepared and sterile draped
- Dr Arora makes a small incision to harvest your hamstring graft
- Small keyhole incisions are made to allow Dr Arora to view inside the knee and prepare the soft tissue and bone to receive the graft
- The graft is prepared and passed into your knee to replace your damaged ACL
- The surgical sites are cleaned and closed
The post-operative recovery consists of:
- The majority of patients that have an ACL reconstruction are discharged on the day of or next day after surgery
- Full weight bearing with crutches for 2 weeks
- Back to School/University 1-2 weeks
- Back to sedentary work by 2 weeks
- Driving by 2-4 weeks
- Manual labour restricted duties 6 weeks, full duties 3-4 months
- Golf 3 months
- Running in a straight line between 3-4 months
- Full contact sports 9-12 months