Anterior Cruciate Ligament (ACL) Reconstruction

Re-building the ACL follow injury, to Restore Knee Stability and Support An Active Lifestyle

If you are an athlete in Perth, Western Australia, who enjoys sports involving sudden stops, jumping, and rapid directional changes, such as rugby, netball, soccer, or basketball, you may be at risk of tearing your anterior cruciate ligament (ACL). The ACL is a critical ligament in the knee that connects the thigh bone (femur) to the shin bone (tibia), providing essential stability and support to the knee joint. It plays a vital role in preventing the tibia from moving too far forward and helps maintain rotational stability. This ligament is particularly important in sports that involve pivoting, turning, or sudden movements.

Injuries to the ACL are unfortunately common in athletes, and Dr Antony Liddell is committed to offering comprehensive care, helping you understand your condition, and guiding you through the surgical options available to restore your knee’s stability and get you back to the activities you enjoy.

INDICATIONS & TIMELINES FOR ACL RECONSTRUCTION SURGERY

ACL Reconstruction Surgery may be recommended for individuals who have experienced a significant ACL tear or rupture, particularly those who lead an active lifestyle or participate in sports that require knee stability. A torn ACL often leads to knee instability, making it difficult to perform everyday tasks or participate in physical activities. If conservative treatments like physiotherapy do not adequately restore function, surgery might be necessary.

The timing of surgery depends on several factors, including the severity of the tear, the patient’s activity level, and any associated injuries, such as meniscal tears. An ACL reconstruction is typically performed after the swelling in the knee subsides and a range of motion is restored.

Dr Liddell will work with you to determine the most appropriate timing for your surgery based on your individual recovery needs.

THE DIFFERENCE BETWEEN ACL REPAIR AND ACL RECONSTRUCTION

Understanding the distinction between ACL repair and ACL reconstruction is essential when considering treatment options for an ACL injury.

ACL Repair: In an ACL repair, Dr Liddell attempts to reattach and stitch the torn ligament back together, aiming to restore the ligament’s original structure. This approach may be considered if the tear is located in an area where blood supply and healing potential are higher, allowing for possible ligament regrowth. However, ACL repair is generally less common, as the ACL typically does not heal well due to limited blood flow within the ligament. Even if reattached, the ACL often lacks the strength and durability needed to withstand future stress, particularly in athletes or active individuals.
ACL Reconstruction: ACL reconstruction is a more widely used and reliable procedure, especially for those looking to restore full knee stability. This technique involves removing the damaged ligament and replacing it with a graft to recreate the ACL. The graft can come from the patient’s own tissue (autograft), typically harvested from the hamstring or patellar tendon, or from a donor source (allograft). Reconstruction is often preferred because it addresses the ACL’s inability to heal itself by replacing it with new, strong tissue that can adapt to the knee’s demands. Over time, the body integrates the graft into the knee, promoting stability and functionality that is crucial for returning to high-impact sports or physically demanding activities.

Considerations for Choosing Repair vs. Reconstruction:

Nature of the Tear: ACL repair is more suitable for certain types of tears, such as those near the ligament’s attachment to the bone, where some blood supply may support healing. For mid-ligament or complete tears, reconstruction is usually recommended.
Patient Activity Level: ACL reconstruction is often favoured for athletes and highly active individuals who place high demand on the knee, as it provides stronger and more reliable long-term stability.
Age and Recovery Goals: In younger or more active patients, ACL reconstruction tends to offer better outcomes in terms of durability and function. However, in select cases or for those with lower physical demands, ACL repair may be considered to preserve the original ligament structure.
Healing and Rehabilitation: ACL reconstruction typically requires a more structured and extended rehabilitation period, focusing on graft integration and muscle strength. However, it generally offers a more predictable recovery and functional result, especially in comparison to repair, which may have a higher risk of re-injury.

Dr Liddell will assess your individual condition, goals, and lifestyle to determine the most appropriate approach, aiming to restore knee function and reduce the risk of future instability or re-injury.

TYPES OF ACL RECONSTRUCTION SURGICAL TECHNIQUES

Dr Liddell offers various techniques for ACL reconstruction, and the surgical approach chosen will depend on your specific needs and lifestyle.

Two common approaches include:

Autograft: In this technique, a tendon from your own body (usually the hamstring or patellar tendon) is used to replace the damaged ACL. This method is commonly used in young, active patients because it offers strong, reliable outcomes for athletes.
Allograft: This technique involves using donor tissue (from a cadaver) to replace the torn ACL. Allografts may be considered for patients who are older, less active, or have had previous ACL surgeries.

Each technique has its advantages, and Dr Liddell will provide personalised advice on which option may be best suited to your needs.

THE ACL RECONSTRUCTION SURGICAL PROCEDURE

ACL reconstruction is typically performed as an arthroscopic surgery, meaning it is minimally invasive and requires only small incisions. The key steps of the procedure include:

Incisions and Arthroscopy: Dr Liddell makes small incisions in the knee and inserts a tiny camera (arthroscope) to view the knee joint and assess the damage.
Graft Harvesting: If an autograft is being used, Dr Liddell will harvest the necessary tendon, either from the hamstring or patellar tendon.
Graft Placement: The damaged ACL is removed, and the graft is prepared. Dr Liddell then drills small tunnels in the femur and tibia to secure the new graft in place.
Securing the Graft: The graft is anchored into place using screws or other specialised devices. The new ligament is tensioned to ensure it is positioned correctly.
Closure and Recovery: Once the graft is secured, the incisions are closed, and the knee is bandaged. A brace or knee immobiliser may be used to support the knee during the initial recovery phase.

POST-OPERATIVE EXPECTATIONS AFTER AN ACL RECONSTRUCTION

Following ACL reconstruction, patients can expect some swelling, pain, and stiffness in the knee, which will gradually improve over time. Pain relief medications and anti-inflammatory treatments may be prescribed to help manage discomfort.

In the first few weeks after surgery, you may need to use crutches and wear a knee brace to protect the graft and allow the knee to heal. Physiotherapy is a critical component of the recovery process and will begin soon after surgery to help restore range of motion, strength, and flexibility in the knee.

Dr Liddell will provide you with a detailed post-operative care plan, which will include instructions on wound care, activity restrictions, and exercises to begin as part of your rehabilitation.

RECOVERY TIMELINES FOLLOWING ACL RECONSTRUCTION SURGERY

The recovery timeline for ACL reconstruction varies depending on several factors, including the patient’s activity level, age, and the extent of the injury. Most patients can expect the following general timeline:

First 6 Weeks: Initial focus on controlling pain and swelling, protecting the knee, and beginning gentle range-of-motion exercises.

6 to 12 Weeks: Progression to strengthening exercises, gradual return to weight-bearing activities, and improved knee stability.
3 to 6 Months: Return to non-impact activities, such as swimming or cycling, with continued physiotherapy to build strength and flexibility.
6 to 12 Months: Return to full activity, including high-impact sports, after completing a comprehensive rehabilitation program.

Dr Liddell will closely monitor your progress and adjust your recovery plan as needed to ensure you are on track to achieving the best possible outcome.

RISKS ASSOCIATED WITH ACL RECONSTRUCTION SURGERY

ACL reconstruction surgery is commonly performed to restore knee stability and function after an ACL injury. While it has a high success rate, it’s important to understand the potential risks and complications associated with the procedure. These can be grouped into general surgical risks, risks specific to ACL reconstruction, and long-term considerations.

GENERAL SURGICAL RISKS

Infection: As with any surgery, there is a risk of infection at the surgical site. Symptoms may include redness, swelling, warmth, and discharge from the incision area. In more severe cases, deeper infections may develop, which could require antibiotics or even additional surgery to address.
Bleeding: While rare, excessive bleeding can occur during or after surgery. In some cases, it may require a blood transfusion or a follow-up procedure to control the bleeding.
Blood Clots (Deep Vein Thrombosis): Blood clots can form in the legs after surgery, potentially leading to serious complications if they travel to the lungs (pulmonary embolism). Preventative measures, such as anticoagulant medications, compression devices, and early mobilisation, can help reduce this risk.
Anaesthesia Complications: Both general and regional anaesthesia carry risks, which may include allergic reactions, respiratory difficulties, or cardiovascular issues. These risks are generally low, but they will be discussed with you prior to surgery.

ACL RECONSTRUTION ‘SPECIFIC’ SURGICAL RISKS

Graft Failure: The new ligament (graft) used to reconstruct the ACL can fail to heal properly or re-tear due to reinjury, overuse, or other factors. This is one of the more significant risks of ACL surgery, especially if patients return to sports too quickly.
Graft Rejection: If an allograft (donor tissue) is used, there is a small risk of the body rejecting the graft, though this is rare. Autografts (tissue from the patient’s own body) generally have a lower risk of rejection.
Knee Stiffness and Loss of Range of Motion: After surgery, it’s possible to experience stiffness or reduced mobility in the knee. Physiotherapy is usually effective in managing this, but in some cases, further surgery may be necessary to address persistent stiffness.
Persistent Pain: Some patients may continue to experience knee pain after surgery. This can be caused by scar tissue formation, nerve damage, or the position of the graft. It is not uncommon for patients to feel a prominent screw near the shin bone as swelling decreases, which can sometimes require removal if it becomes problematic.
Nerve Damage: There is a small risk of nerve injury during the procedure, which could lead to numbness, tingling, or weakness in parts of the leg. While these issues are often temporary, in rare cases they can be permanent.
Numb Spots: It is fairly common to experience areas of numbness around the knee or down the leg following surgery. While this is usually not permanent, it may persist for some time.
Patellar Issues: If the patellar tendon is used for the graft, there may be soreness or discomfort around the kneecap, especially when kneeling. There is also a risk of patellar fracture or patellar tendon rupture, although these complications are rare.

MITIGATTING ACL RECONSTRUCTION SURGICAL RISKS

While the risks associated with ACL reconstruction cannot be completely avoided, Dr Liddell takes several steps to help reduce these risks and promote successful recovery:

Pre-Surgical Preparation: Dr Liddell may recommend pre-habilitation exercises before surgery to strengthen the muscles around the knee and improve flexibility, which can help support recovery. Ensuring you are in optimal health before surgery can also lower the risk of complications.
Post-Surgical Rehabilitation: A well-structured physiotherapy program is essential to regaining knee strength, range of motion, and stability after surgery. Patients who adhere to their rehabilitation plan are more likely to achieve successful outcomes and avoid re-injury.
Patient Education: Dr Liddell provides comprehensive information about what to expect after surgery, including guidance on activity restrictions and realistic timelines for recovery. Understanding these limitations is key to avoiding complications and returning to regular activities safely.