Impingement

Knee Conditions

– Things that cause ACL issues

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.

– Symptoms of an ACL issue

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.

– Treatment options for ACL issues

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.

How is an ACL injury treated? Surgical vs Non-surgical management

An ACL tear (rupture) is a significant knee injury and is often associated with other intra-articular injuries. Treatment options include both non-surgical and surgical methods and are tailored to a specific individuals needs. Factors considered include activity levels, sporting involvements and goals, medical fitness and to a lesser extent age. 

Initial  treatment consists of controlling pain and swelling through rest, ice, compression, and elevation (RICE protocol). Physical therapy is often recommended to improve knee motion and strength. For a short period a knee brace may be needed to help immobilise the knee.

Some patients may be able to regain a functionally stable knee without surgery by improving their proprioception (reflexes and joint position awareness) and  strengthening their thigh and calf muscles. However conservatively managed patients may continue to avoid certain rotational activities and may be unable to return to their pre-injury level of exercise or sport.  Those involved in pivoting sports or with a particularly active lifestyle may require surgery to safely return to sport/activity. The clearest indication for surgery is in patients with the knee frequently giving way. Recurrent episodes of instability may potentially damage the articular cartilage (shiny surface ), menisci (shock absorbers) or other ligaments within the knee resulting in poorer long-term outcomes.  The usual surgery for an ACL tear is an ACL reconstruction which replaces the torn ligament with a graft (tissue taken from another place). This may be from the same patient (autograft) and usually is either the hamstring tendons, bone patella tendon or the quadriceps tendon. Allograft (taken tissue from a donor who has passed away) may be also be used with advantages and disadvantages for both. This should be discussed with your surgeon in detail  before surgery. In a very small group of patients with specific indications the ACL may be repaired by reattaching it to the femur or tibia if it has detached (pulled off). This requires a specific skill set and should be discussed with your surgeon to see whether this is appropriate or applicable. 

ACL reconstructive surgery is performed with an arthroscope (special camera via keyhole surgery) using small incisions. The ruptured ligament is removed and tunnels (holes) in the bone are drilled to accept the ACL graft. This graft which replaces the patient’s old ligament is prepared to take the form of a new tendon and passed through the bone tunnels. The new tendon is then fixed into the bone with special mechanical devices to hold it in place while the ligament heals into the bone (usually 3-6 months).

The wound is closed with absorbable sutures and a dressing is applied.

As surgical techniques have improved significantly over the last decade, complications are reduced and recovery much quicker than in the past.

Following ACL reconstruction, a rehabilitation program with physiotherapy is started to help you to ultimately return to sport and a wider range of activities. Many patients are able to begin a phased return to contact sports by 9 months post-surgery. This is dictated by patients meeting milestones and under the supervision of the surgeon and specially trained physiotherapist.