Ligament joint injuries and ACL reconstruction
The anterior cruciate ligament (ACL) is one of the most common in the body to be injured. Serving to stabilise the knee joint, it connects the thighbone (femur) to the shinbone (tibia).
Roughly 75% of ACL ruptures happen with minimal or no contact at the time of injury, and 70% of patients feel or hear a popping sound as it occurs.
Symptoms & treatment
Ligamentous injuries in the knee typically present with severe pain and rapid swelling, often accompanied by a loud ‘popping’ sound or sensation at the time of injury.
The knee then feels quite weak and unstable, being unable to bear weight or giving way on attempts to walk.
Treatments for ligament joint injuries
Immediate treatment for ligamentous injuries involves elevating and resting the injured limb. Ice packs and over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can assist in pain management and relieve swelling. Prompt assessment by a medical professional is essential in determining further treatment.
If a small tear is present to the ACL, ongoing conservative management and physiotherapy may be sufficient. As the ACL tendon does not heal or regrow on its own, reconstructive surgery is generally required to manage large ruptures.
ACL reconstruction surgery
ACL reconstruction involves replacing the torn ligament with a graft from another source.
This is usually taken from your own body – a hamstring graft is most commonly used. Other donor sites may be quadriceps or patella tendon.
The surgeon then drills a small hole in the upper and lower leg bones. The replacement ligament is threaded through the opening and secured in place using endo button fixation or bone screws. This is performed arthroscopically.
Over 50% of all ACL ruptures have an associated injury to the meniscus, which may require a varied or separate surgery to effectively treat. Learn more about meniscal injuries and repairs by following the link.
Indications for ACL reconstruction
The need for surgery is typically based on the patient’s lifestyle and extent of injury. As the ACL serves to stabilise the knee, patients who are not physically active and do not require a high degree of knee stability may not require reconstruction.
These cases are often best managed through physiotherapy to strengthen the knee joint and long-term activity modification (avoiding sports and heavy lifting)
ACL reconstruction is almost always required in the case of ACL injury with symptomatic instability, as the ligament cannot reattach itself.
In cases where a section of bone has detached alongside the ligament (avulsion fracture) or the ACL has torn from its attachment, the ACL may be repaired instead of reconstructed.
Recovery from ACL reconstruction
Immobilisation of the knee is usually not required following an ACL reconstruction. You will be allowed to stand as soon as you feel able, aided by crutches or another walking aid. Most patients are confident in walking without crutches a few weeks post-procedure.
Physiotherapy will guide your post op rehabilitation. Most patients can return to sporting activity at around 12 months.
Driving after an ACL reconstruction is not recommended until the patient does not require narcotic painkillers and can safely perform an emergency stop. This is typically 4-6 weeks following the procedure; Dr Jonathan Cabot will provide specific advice prior to your procedure. Bear in mind that some insurance providers have other requirements and these should also be considered.