If you have you have sustained a tear of your anterior cruciate ligament, you either need physiotherapy for functional rehabilitation or you may need ACL reconstruction surgery. Every patient has their own circumstances and Dr Connon can discuss with you whether you require surgery or whether you should trial functional rehabilitation with a physiotherapist initially. Research has shown that some patients can live a totally normal life without an ACL reconstruction, whereas others require surgery to get them back to doing the activities they love. It’s about what’s right for you as an individual.
Research shows that patients recover better from their ACL reconstruction if they perform physiotherapy beforehand to ensure they can get their knee fully straight and to build the strength of their secondary stabilising muscles to protect the graft postoperatively.
Anaesthesia for ACL reconstruction surgery is usually a general anaesthetic. The operation takes about one hour.
Dr Connon will make several keyhole incisions around the knee.
One 1cm incision is for the camera to get a good look at the knee joint, and a second 1cm incision is for instruments that can be used to place the tunnels for the ACL graft
A further incision is made to harvest the graft (hamstring or quadriceps) to reconstruct your ACL.
After creating a tunnel in the thigh bone (femur) and shin bone (tibia), the graft is placed inside the knee joint, tightened and held in place with a dissolving screw in each bone.
ACL reconstruction often involves a one-night stay but can be done as day surgery. A physiotherapist will make sure you are comfortable walking (either with or without the assistance of crutches) and help you to straighten your knee which will be the first objective of your physio. You will be given some tablets in case you need them to treat your discomfort. If you’ve also had a meniscal repair, you may have a brace on and need to use the crutches to minimise your weightbearing. If you have just had an ACL reconstruction alone or a meniscal tear has simply been trimmed up then you will be able to weight-bear normally.
Physiotherapy will then be the main component of your treatment and Dr Connon will liaise with your physiotherapist to keep you on track.
A physiotherapist will make sure you are comfortable walking (either with or without the assistance of crutches) and help you to straighten your knee which will be the first objective of your physio. If you’ve had a meniscal repair, you may have a brace on and need to use the crutches to minimise your weightbearing. If you have just had an ACL reconstruction alone or a meniscal tear has simply been trimmed up then you will be able to weight-bear normally.
If you’re comfortable and safe walking you will be able to head home today. Focus on getting that knee as straight as possible!
After 2-3 weeks, your wound will be checked (usually by a specialist wound nurse). Dr Connon will normally use dissolving suture so no suture removal is likely to be required. After your wound review you should arrange to see your physiotherapist to continue post-operative exercises.
By this stage you should be getting back to a more normal existence. You should be able to fully straighten your knee and focus on progressing to more difficult exercises with your physiotherapist. If you have a brace from a meniscal repair, you will be able to remove that brace at this point and weight-bear normally though you should still avoid deep squats.
You will be doing exercises of gradually increasing difficulty with your physiotherapist. Initially these will involve increasing your strength, then you can progress to running in a straight line before moving onto changing direction. Returning to high-speed pivoting and contact sports can take up to 9-12 months and is dependent on your progress with physiotherapy as an individual.
Infection occurs in less than 1% of patients undergoing keyhole surgery but is very serious and should be treated promptly. Please contact Dr Connon’s rooms if at all concerned about this risk.
Re-rupture of the ACL graft can occur and is more likely in patients who ruptured their ACL in the first place because such individuals generally enjoy high-speed pivoting sports and may have a predisposition to rupture due to anatomy, genetics or flexibility. Of note, if you return to sport following an ACL rupture, research has shown that you are just as likely to rupture the other knee’s ACL as the one that has been reconstructed.
