| CHRIS
SERVANT |
| ANTERIOR CRUCIATE
LIGAMENT (ACL) RECONSTRUCTION |
What are the treatment
options? |
| The aim of treatment is to make the
knee stable enough to allow the patient to return to their
desired level of activity without risk of further injury to
the knee. Each patient has different requirements. |
Non-surgical
treatment |
| Physiotherapy is extremely important
after any ACL injury, both as part of non-surgical treatment
and also as part of the recovery following surgery. It is
important to regain your range of movement and also strengthen
both the quadriceps (the muscle on the front of the thigh) and
the hamstrings (the muscles on the back of the thigh).
Balancing and proprioception (the body's ability to sense the
position of a joint) should also be developed with agility
training. It normally takes 6 months to complete a full
rehabilitation programme. |
| Some people are able to cope well
without an ACL by building up their thigh muscles with
physiotherapy and learning to avoid twisting activities or
sudden changes in direction. This usually limits them to
sports such as cycling, swimming and running in straight
lines. |
| However, if you are likely to get
involved in twisting activity on a regular basis, an ACL
reconstruction may be the best option. |
Surgical treatment (an ACL
reconstruction) |
| Frequent giving way of the knee places
the knee at risk of repeated injury, resulting in meniscal
tears (cartilage tears) and damage to the joint surface, which
can lead to osteoarthritis. |
To prevent this, the following patients
are recommended to undergo an operation known as an ACL
reconstruction:
- Patients who wish to continue activities that require
twisting movements (such as running ball sports or skiing)
- Patients who experience instability (giving way) during
routine daily activities
- Patients who are at particular risk if their knee gives
way (such as people who work on ladders or people who carry
heavy or fragile loads)
|
| The torn ends of the ACL cannot be repaired
and so the ACL must be replaced, or reconstructed, using a piece of
tendon (known as a graft). Tendons attach muscles to bone and are
very similar to ligaments. |
Two types of tendon graft are used commonly:
- Patella tendon. The middle of the tendon running
between the patella (kneecap) and the front of the tibia (shin)
is used, along with small blocks of bone attached to either end.
Because of the bone blocks the fixation of this graft is strong.
Some patients find that they end up with some pain around the kneecap
and shin, especially with kneeling.
- Hamstring tendon. The hamstring tendons run from the back
of the thigh around the inner side of the knee to the front of the tibia.
The fixation of the graft may not be as secure as with a patellar tendon
graft. However, pain at the front of knee, especially knee pain, is less likely.
|
| Both types of graft have excellent results. |
|
