The anterior cruciate ligament (ACL) is a major stabilising ligament in the knee. It is a rope-like structure located in the centre of the knee and runs down from the femur to the tibia. One of the primary functions of the ACL is to provide stability during rotational movements, such as twisting, turning and sidestepping.
Consequently, injuries to the anterior cruciate ligament (for example, an ACL tear or ACL rupture) are common in sports, especially those that involve sudden stops and changes in direction. To repair a torn ACL, an ACL reconstruction may be required to be performed by an orthopaedic surgeon – a doctor who specialises in orthopaedics and, more directly, surgical procedures of the bones and joints.
So, when is an orthopaedic surgeon likely to perform surgery?
A course of physical therapy may successfully treat an ACL injury for somewhat inactive people, people who only engage in moderate exercise or people that play sports that put less stress on the knee. However, most patients who suffer an ACL tear or ACL rupture are recommended to have it surgically reconstructed, especially for those who wish to go back to sport or their work requires them to be physically fit.
In general, the younger and more active you are the more likely it is that an orthopaedic surgeon will perform an ACL reconstruction. Many people who suffer a torn ACL but do not have surgery may find that their knee becomes loose and is prone to give way during daily activities. These patients should strongly consider surgery to stabilise the knee.
What are the risks of not having surgery?
The repeated instability and abnormal movement the knee may suffer from not having an ACL reconstruction may cause ongoing damage. Eventually, this could lead to the stretching of other structures in and around the knee, meniscal tears or arthritis in the long term. If a patient elects not to have surgery it is strongly advised that they give up sports that involve pivoting, sidestepping or rotation.
How is an anterior cruciate ligament surgery performed?
Before an ACL reconstruction, patients will often be required to undergo physical therapy for at least three weeks to gain full range of motion of their knee. Patients who have an ACL reconstruction while their knee is still stiff, swollen and limited in motion will tend to have problems regaining motion after surgery.
An orthopaedic surgeon will perform an ACL reconstruction in a hospital or outpatient setting, using a connective tissue graft to rebuild or replace a torn ACL or ACL rupture. An anterior cruciate ligament is rarely sewn back together, therefore a graft is required – you can expect your body to heal around the graft over 6 months.
During the ACL reconstruction, the orthopaedic surgeon will insert special instruments and an arthroscopic camera through small incisions in the knee. This camera transmits pictures of the inside of your body to a video screen that is viewed by the surgeon, allowing them to thread surgical tools around the structures instead of cutting through or displacing them as in open surgery.
Doctor Julian Lane is a lower limb orthopaedics specialist. If you are experiencing an injury related to sport, work or otherwise, contact the friendly team at Lane Orthopaedic Surgery today on 07 3394 4228 to organise an appointment with an orthopaedic surgeon.