ACL (Anterior Cruciate Ligament) Reconstruction
ACL is an acronym for the ‘anterior cruciate ligament’. It is an important ligament that is found in the centre of the knee, and it helps to maintain knee stability by preventing forward and twisting movements of the tibia (or shin bone) relative to the femur (or thigh bone). Injuries to the ACL are common. They usually occur due to twisting, non-contact injuries during sporting activities such as soccer, basketball or netball.
The risk factors for ACL injuries include female gender and familial predisposition. The diagnosis of an ACL injury is made after a thorough clinical assessment of the knee. MRI scans are done to confirm the diagnosis and to look for concomitant knee injuries, such as meniscal tears and cartilage injuries.
Some patients with isolated tears of the ACL may be treated non-surgically with a course of rehabilitation. However, patients with symptoms of recurrent knee instability, those with concomitant repairable meniscal tears, and individuals who are keen to return to competitive pivoting sports (such as soccer, basketball or netball) are candidates for surgical treatment.
Surgical treatment involves ACL reconstruction. This surgery is usually performed under general anaesthesia, using minimally invasive arthroscopic (keyhole) techniques. The surgery essentially involves replacing the torn ACL with a new ACL graft. Bone tunnels are drilled in the femur and tibia within the knee, and a new ACL graft is secured within these tunnels. This new graft may be obtained from patient himself (autograft) or from a donor (allograft). At the same time, concomitant injuries to the menisci or cartilage may be repaired. An overnight stay in hospital is usually required after ACL reconstruction and 2-4 weeks of crutch-assisted ambulation may be advised.
The rehabilitation process after the surgery is supervised by a physiotherapist, and consists of progressive knee range of motion exercises, muscle strengthening exercises, and sport-specific drills. The whole rehabilitation process may last 9-12 months following the ACL reconstruction procedure. The success rate of ACL reconstruction surgery has been reported to be about 90%. The complications of this procedure include ACL graft injury, knee stiffness and infection.
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