Introduction
The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope like structure located in the centre of the knee running from the femur to the tibia. When this ligament tears unfortunately it doesn’t heal and often leads to the feeling of instability in the knee.
ACL reconstruction is a commonly performed surgical procedure and with recent advances in arthroscopic surgery can now be performed with minimal incisions and low complication rates.
Function
The ACL is the major stabilizing ligaments in the knee. It prevents the tibia (Shin bone) moving abnormally on the femur (thigh bone). When this abnormal movement occurs it is referred to as instability and the patient is aware this abnormal movement.
Often other structures such as the meniscus, the articular cartilage (lining the joint) or other ligaments can also be damaged at the same time as a cruciate injury & these may need to be addressed at the time of surgery.
History of Injury
- Most injuries are sports related involving a twisting injury to the knee
- It can occurs with a sudden change of direction, a direct blow e.g., a tackle, landing awkwardly.
- Often there is a popping sound when the ligament ruptures.
- Swelling usually occurs within hours.
- There is often the feeling of the knee popping out of joint.
- It is rare to be able to continue playing sport with the initial injury.
- Once the initial injury settles down the main symptom is instability or giving away of the knee. This usually occurs with running activities but can occur on simple walking or other activities of daily living.
Diagnosis
The diagnoses can often be made on the history alone. Examination reveals instability of the knee, if adequately relaxed or not too painful. An MRI (Magnetic Resonance Imaging) can be helpful if there is doubt as well as to look for damage to other structures within the knee.
At times the final diagnoses can only be made under anaesthetic or with an Arthroscopy.
Treatment
Initial
- Rest
- Ice
- Compression
- Elevation
- Bracing if Medial Collateral ligament is injured
Indications for surgery
- Young patients wishing to maintain an active lifestyle. Sports involving twisting activities e.g., Soccer, netball, football.
- Giving way with activities of daily living.
- People with dangerous occupations e.g. Policemen, firemen, roofers, scaffolders.
Type of ACL Graft
The graft, which replaces your old ACL, is taken either from the hamstring tendons or the patella tendon. There are advantages & disadvantages of each which will be discussed with you. The vast majority performed at Perth Hip and Knee involve the use of hamstring tendon graft.
LARS artificial grafts were popularised in the media but high failure rates have meant these are now reserved for special circumstances. We are happy to discuss this with you.
