Knee Anterior Cruciate Ligament (ACL) Reconstruction

Commonly, the ACL 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 swelling of the knee joint. The knee may give way when you try to walk on the knee, particularly changing directions.

Dr Agolley will take a thorough history and examination to help make the diagnosis of an ACL injury.

Plain x-rays of the knee are essential. Often an MRI scan is performed to help confirm the diagnosis, and to assess other injuries of the knee 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 that you have a reconstruction. However the concern is that of repeated injury of the knee that may cause cartilage injury and early progressive arthritis.

ACL ruptures can be managed non-operatively, 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:

1. Those that are participating at a high level of sport, and have high demands of their knee, where they want to part take in activity and sporting activities that require more stability in the knee where they would likely damage their knee if the ACL is not reconstructed
2. 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 to reconstruct the knee. Dr Agolley uses modern arthroscopic reconstruction techniques, and prefers to use the patients own hamstring tendons, and where necessary bone-patella tendon-bone graft. Donated graft (Allograft) is also used in select cases where necessary.

Dr Agolley has a special interesting in performing revision ACL reconstructions for re-injured knees having had a previous ACL reconstruction.

The specific type of procedures required during your ACL reconstruction will be discussed with you prior to the procedure. In general for most patients:

• Your anaesthetist will perform general anaesthetic
• Your knee is prepared and sterile draped
• A small incision is made to harvest your hamstring graft
• Small keyhole incisions are made 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

There may be numbness around the surgical site. This usually resolves quickly, but may persist for a few weeks. Major nerve or blood vessel injury is extremely uncommon. Blood clots in the legs and lungs are also extremely uncommon and usually do not require prophylactic medical therapy. Infection is very uncommon. Repeat arthroscopy is uncommon, but if you require a meniscal repair at the time of surgery, 80% heal and 20% do not heal. Some of those that do not heal require repeat arthroscopy for related symptoms. Re-rupture of the graft or uninjured ACL is 1% per knee per year (as you have proven to be the type of person who can rupture a native ACL, there is a chance that you may injure your other ACL as well as your reconstructed ACL). Performing ACL injury prevention exercises will minimise this risk.

For more information, see the American Academy or Orthopaedic Surgeon website.