Anterior Cruciate Ligament (Acl) Reconstruction Surgery
Restoring Knee Stability and Function After Injury
Your anterior cruciate ligament (ACL) is one of the four key ligaments in the knee, and its name is often well-known among athletes who fear the dreaded ACL tear. Fortunately, significant advancements in ACL repair and reconstruction techniques over the past decade have transformed what was once a potentially career-ending injury into a manageable setback for most athletes. With proper treatment and rehabilitation, many individuals can now return to the sports and activities they love.
Dr. Keeley has extensive expertise in treating ACL injuries and other knee ligament issues. He is dedicated to helping athletes and active individuals recover fully, restoring knee stability and function so they can get back to doing what they are passionate about.
Restoring Knee Stability and Function After Injury
Dr Keeley may recommend surgery if:
- You have a complete ACL tear or a severe partial tear.
- You experience significant knee instability that affects your daily activities.
- You wish to return to high-demand sports or physical activities.
- You have associated injuries to other knee structures, such as meniscus tears.
For a complete ACL tear, reconstruction surgery is typically scheduled between 3 to 6 weeks after the injury. This timing allows inflammation in the knee to subside and provides an opportunity for physiotherapy to restore normal knee flexion and extension.
Performing surgery too early, when the knee’s range of motion is still limited, can lead to a condition called arthrofibrosis, a scarring response that results in stiffness. On the other hand, delaying surgery beyond three months increases the risk of developing irreparable cartilage damage or meniscus injuries due to ongoing knee instability.
Evidence suggests that postponing ACL reconstruction surgery for six months or more after the injury can heighten the risk of further meniscus or cartilage damage and increase the likelihood of requiring ACL revision surgery in the future.Finding the optimal timing for surgery is crucial and begins with a thorough consultation with Dr Keeley. He will carefully assess your condition to determine the best approach and timing for your surgery, ensuring the best possible outcome for your recovery and return to activity.
TYPES OF ACL RECONSTRUCTION SURGICAL TECHNIQUES
ACL reconstruction surgery aims to restore knee stability and function by replacing the torn ligament with a tissue graft. Dr Keeley may choose from three primary types of grafts based on your specific needs:
AUTOGRAFTS
Autografts involve using tissue from your own body, typically sourced from the patellar tendon, hamstring tendon, or quadriceps tendon:
Hamstring Tendon Autograft – This is one of the most commonly used grafts for ACL reconstruction worldwide. The procedure involves harvesting one or two hamstring tendons (usually the semitendinosus and/or gracilis) from your leg and shaping them into a new ACL. This method is popular due to the tendons’ availability and the low complication rate after surgery. Some patients may experience pain in the back of the thigh post-operatively, so it’s important to avoid aggressive hamstring exercises during the early recovery period. However, the harvested tendons typically heal over time, resulting in minimal long-term weakness.
Patellar Tendon Graft: The patellar tendon graft, which includes bone blocks at each end, has been a reliable option for ACL reconstruction for many years and remains a preferred choice for certain patients. This technique involves harvesting the middle third of the patellar tendon from the front of the knee while leaving the rest of the tendon intact. This approach minimally impacts the tendon’s overall power and function. Dr Keeley may recommend this method based on specific patient factors and surgical indications.
Quadriceps Tendon Graft: The quadriceps tendon graft has long been a dependable choice for ACL reconstruction and has recently gained renewed popularity. This technique involves harvesting a portion of the quadriceps tendon through a small incision above the kneecap and fashioning it into an ACL graft using sutures. The quadriceps tendon graft is associated with reduced post-operative pain and offers a high-quality graft, making it an increasingly preferred option for both surgeons and patients.
ALLOGRAFT
Allografts involve using donated tissue for the graft, similar to the use of bone grafts or blood donations in other medical procedures. Various types of allograft materials can be utilised based on the specific needs of the patient. Allografts undergo rigorous testing and approval processes to ensure their safety and effectiveness for surgical use.
Synthetic Tissue Graft: Synthetic grafts, such as the LARS (Ligament Augmentation Reconstruction System) graft, are made from durable synthetic materials. The primary advantage of synthetic grafts is that they do not require tissue from the patient or a donor. In some cases, synthetic ligaments are combined with traditional grafts, like hamstring grafts, to benefit from the strengths of both materials. However, the use of LARS grafts alone can be controversial and has attracted significant media attention.
Dr Keeley typically performs ACL reconstruction using arthroscopic, minimally invasive, autograft techniques. These approaches promote faster recovery and reduce post-operative discomfort, ensuring a smoother rehabilitation process for patients.
RECOVERY TIMELINES FOLLOWING ACL RECONSTRUCTION SURGERY
Recovery from ACL reconstruction surgery involves a collaborative approach between you, Dr Keeley, the physiotherapist, your GP, and other healthcare professionals with an individualised treatment plan being essential to meet your specific goals.
The focus on pain relief, wound healing, restoring near full knee extension, and weaning off crutches. Weight-bearing as tolerated (WBAT) with crutches for support is encouraged. Physiotherapy emphasises rest, ice, compression, elevation (RICE), range of motion (ROM) exercises, and static quadriceps exercises.
Continue pain management and wound healing. Aim for full knee extension and flexion above 90 degrees, normalise walking patterns, reduce swelling, and build muscular control and core strength.
The focus on improving balance, proprioception, and muscular strength. Introduce power exercises, gentle running, and gradual changes in direction. Build confidence in knee stability.
Begin sport-specific training, focusing on landing, jumping, and directional changes. Gradually reintroduce team training, enhance stamina, and reduce muscle fatigue.
Continue sport-specific skills and drills, progress to full training, and prepare for game simulations. Aim for a side-to-side knee strength difference of less than 10%, ideally under 5%, to minimise re-injury risk.
Achieve higher-level sport-specific skills, fully return to training and competition, and ensure readiness for sport with minimal risk of re-injury.
By adhering to this recovery timeline and working closely with Dr Keeley and your healthcare team, you can successfully recover from ACL reconstruction surgery and return to your desired level of activity.