ACL Injury & Reconstruction
What are the symptoms?
You might have injured your ACL if you experience the following:
Hearing a loud ‘pop’ in the knee and experiencing severe pain afterwards: People who suffer an ACL tear may hear a loud ‘pop’ at the time of the injury. Even if you don’t hear the pop, you will feel a sudden shift in the joint.
Pain and swelling: Swelling of the knee joint occurs in almost all patients with an ACL tear. This swelling is usually quite large and occurs rapidly after the injury. The swelling that occurs with a torn ACL is actually a hemarthrosis, meaning the knee joint is filled with blood. The ACL has a blood vessel within the ligament that is torn t the time of injury, causing this hemarthrosis. Pain is often associated with an ACL tear but this can vary depending on the amount of damage caused in and around the knee joint.
Lack of stability: The ACL is critical to the stability of the knee joint and when an ACL tear occurs, the knee joint becomes unstable. This means that the knee joint has a tendency to give out. Giving out usually occurs with cutting or pivoting movements common in many sports. However, in some patients with an ACL tear, instability can occur with simple movements such as walking or getting into a car.
Loss of full range of movement: After ACL injury many patients report a loss of full range of movement of the leg and knee. Patients may also have difficulty straightening the knee.
What is ACL reconstruction surgery?
This surgery is designed to correct a torn anterior cruciate ligament. The anterior cruciate ligament (ACL) is one of the important ligaments that stabilize your knee joint (see figure 1). If you have torn (ruptured) this ligament, the knee can collapse or ‘give way’ when making twisting or turning movements.
An ACL rupture happens as a result of a twisting injury to the knee. It can be injured if you are changing direction rapidly, landing from a jump incorrectly, stopping suddenly or having a direct collision. The ligament tear is a common sports injury that usually happens whilst playing sports such as football, rugby, tennis or skiing. You can injure other parts of your knee at the same time; for example, tearing a cartilage or damaging the joint surface.
What should I do before my surgery?
Mr Hoad-Reddick will examine your injured knee and assess the damage. He may also use X-rays or an MRI scan to confirm the diagnosis.
If your ACL reconstruction surgery is successful, your knee should no longer give way and this will allow you to be more active and return to some or all of your sporting activities. However, it is unlikely that your knee will ever be as good as it was before the ACL tear.
When you meet with Mr Hoad-Reddick in clinic you will have the opportunity to ask any questions you may have and he will discuss the procedure with you.
Your insurance company will need a procedure code for the operation which is W7420.
Are there any alternatives to surgery?
Having physiotherapy can strengthen and improve the coordination of the muscles in your thigh. This can often stop your knee giving way in everyday activities. Wearing a knee brace can sometimes help during sporting activities. Having surgery depends on the level of damage to the knee and how it affects you life. If you have an active lifestyle then not having ACL surgery could result in further damage to your knee joint.
What happens during ACL reconstruction surgery?
A variety of anaesthetic techniques are possible; you can have a general anaesthesia and be unconscious throughout the operation, or you can have a spinal anaesthetic that will numb your lower body only.
The ACL reconstruction surgery usually takes 60 to 90 minutes to complete. Mr Hoad-Reddick performs the surgery by arthroscopy (‘keyhole’ surgery) using a camera to see inside the knee. The ACL will be replaced with a piece of suitable tissue from elsewhere in the body. The top and bottom ends of the replacement ligament are fixed with special screws or anchors into ‘tunnels’ drilled in to the bone.
What are the risks associated with ACL reconstruction surgery?
As with any operation, ACL reconstruction carries risks; the majority of patients undergoing such surgery will encounter no significant complications. A comprehensive list of the potential risks associated with ACL surgery is below.
Complex Regional Pain Syndrome: Consistent and severe residual pain. Many cases of CRPS gradually improve to some degree over time or get completely better. However for some patients CRPS never completely goes away and the affected patient will experience pain for many years.
Infection: To reduce infection risk, surgery is performed in a specially ventilated ‘clean air’ operating theatre and most patients are given a short course of antibiotics at the time of surgery. Despite these measures deep infection can occur in 1:100 cases necessitating removal of the artificial joint until infection has cleared. This would also be treated with antibiotics.
Blood clot (DVT): Occasionally a blood clot can form in the deep veins of the leg causing pain or swelling in the calf, in a minority of cases this can break away and travel to the heart or lungs and become a risk to life. The overall risk of fatal lung clot is 1:600. To reduce this risk you will be given calf pumps to increase the blood flow and an anticoagulant drug to inject into your stomach for twenty eight days following surgery, in keeping with current recommendations from the National Institute for Clinical Excellence (NICE).
Residual pain: In the majority of cases, knee replacement significantly improves pain and mobility; residual pain and stiffness can occur and in most cases will resolve in time.
Neurovasuclar injury: Very rare occurrence of damage to vessels or nerves in the region of surgery.
What will my recovery be like?
Depending on your overall health, age and extent of the damage, you may be able to go home the same day as surgery or spend the night in a ward.
You may have to wear a knee brace for the following weeks. Once the knee begins to settle down you will need to start intensive physiotherapy treatment which may continue for as long as six months.
Regular exercise should help you return to normal activities as soon as possible. A physiotherapist will advise you on what kind of exercises you should do for recovery. It is unlikely that your knee will ever be quite as good as it was before the injury.