ACL Reconstruction
The aim of ACL surgery is to reconstruct the torn ACL. This surgery is performed for the most part arthroscopically (key hole). There are varying techniques used and Jonathan will discuss this with you in order to personalise your surgery according to your level and type of sport being played. Methods of personalisation include graft type and size and whether any other procedure would be of benefit to further stabilise your knee. The most commonly used grafts Jonathan uses are your own hamstring, quadriceps or patella tendon. These are then fixed with metal buttons on the outside of the bone. There are pros and cons of each method used, and these will be discussed on an individual basis. ACL reconstruction is usually performed under a general anaesthetic. After the predetermined graft is harvested, the inside of the knee is prepared to take the graft into the anatomically correct position of the native ACL. Bone tunnels are created in the tibia and the femur to accept the graft, and the graft is then pulled through both tunnels and secured in place. Over time the new ACL graft gets incorporated into the bony tunnels, however this usually takes up to 12 months (or longer) to fully mature.
This procedure can be performed as day surgery, however most people tend to stay in hospital overnight and are discharged the following morning.
While the procedure itself is a fairly short one, the rehabilitation is much more lengthy and involved. Careful adherence to post-operative advice from your surgeon and your physiotherapist is essential to ensure that you have the best possible outcome. While an accelerated rehab programme is used, most patients are rarely fit for return to competitive (contact or high speed non-contact) sport until 9-12 months post-op.
Unless a complex meniscus repair is undertaken in conjunction with your ACL reconstruction, you will be permitted to bear weight on your operated leg, with the use of crutches. The crutches are required until good thigh (Quadriceps) muscle control returns and you and your physiotherapist feel that you are safe to hold the knee in a straight position. This is usually around 1-2 weeks. Over the following weeks, you will initially aim to control pain and swelling and then regain a full range of movement. Once this is achieved, the next emphasis is to regain muscle strength and balance. By about 12 weeks post-op you can usually commence in-line running, e.g. on a treadmill/even ground, by approximately 5-6 months you may start running. Pivoting can be achieved by 9 months post op after careful assessment, however it is not uncommon for this important part of your rehab to be delayed until all other hurdles have been successfully achieved in a safe manner. By 12 months you should be aiming for return to sport specific training with resumption of competitive sports following at least 4 weeks of sport-specific training.
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ACL Post Op Guidelines