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The Anterior Cruciate Ligament (ACL) is one of the main ligament stabilisers of the knee joint that resists:
- The tibia from translating forward of the femur
- Hyperextension of the knee joint
- Varus (bow legged) and valgus (knocked knee) deformity of the knee
- Rotation of the femur on the tibia
The ACL is a commonly injured ligament of the knee. Dr Agolley is a knee surgeon on the Gold Coast who performs arthroscopic assisted ACL reconstruction through mini incisions.
What are the symptoms?
Commonly, the ACL is injured in a non-contact injury where the knee ‘twists’ during foot landing or push-off. The feeling or sound of a “pop” may be experienced, with pain and a rapid joint swelling. The knee may give way when you try to walk, particularly changing directions.
Dr Agolley will take a thorough history and examination to help make the diagnosis of an ACL injury.
What investigations will be required?
Plain knee x-rays are essential. Often the surgeon requests an MRI scan to help confirm the diagnosis, and to assess other knee injuries such as bone bruising, meniscal tears and other ligament tears that may require treatment.
When should I have surgery?
As with many orthopaedic injuries, an ACL rupture is not life threatening, and it is not essential for a surgeon to perform a reconstruction. However the concern is that repeated knee injury from an ACL unstable knee, will cause repeated cartilage damage, early progressive arthritis and pain in the knee, necessitating additional intervention by a surgeon.
ACL ruptures can be managed without the assistance of a surgeon if the patient is able to live within their envelope of stability by avoiding sports and movement that reproduce knee instability.
The operative management of ACL rupture is indicated in the individual who is unable to live within the envelope of stability in the injured knee. These individuals generally fall in to two groups:
- Those that are participating at a high level of sport, and have high demands of their knee, where they want to take part in activity and sporting activities that require more stability in the knee where damage would likely occur if the ACL is not reconstructed
- Those that may not participate at a high level of sport, but find that their knee is unstable with activities of daily living and recreational activities.
There are a variety of methods and graft types surgeons use to reconstruct the knee. Dr Agolley uses modern arthroscopic ACL reconstruction techniques, and prefers to use the patient’s own hamstring tendons, and where necessary bone-patella tendon-bone graft. Donated graft (Allograft) is also used in select cases where necessary.
Dr Agolley has a special interest in performing revision ACL reconstructions for re-injured knees having had a previous ACL reconstruction.
The procedure and post-operative recovery
The specific type of procedures required during your ACL reconstruction will be discussed with your surgeon prior to the procedure. In general for most patients:
- Your anaesthetist will perform general anaesthetic
- Your knee is prepared and sterile draped
- Dr Agolley makes a small incision to harvest your hamstring graft
- Small keyhole incisions are made to allow Dr Agolley to view inside the knee and prepare the soft tissue and bone to receive the graft
- The graft is prepared and passed into your knee to replace your damaged ACL
- The surgical sites are cleaned and closed
The post-operative recovery consists of:
- The majority of patients that have an ACL reconstruction are discharged on the day of or next day after surgery
- Full weight bearing with crutches for 2 weeks
- Back to School/University 1-2 weeks
- Back to sedentary work by 2 weeks
- Driving by 2-4 weeks
- Manual labour restricted duties 6 weeks, full duties 3-4 months
- Golf 3 months
- Running in a straight line between 3-4 months
- Full contact sports 9-12 months
There may be numbness around the keyhole scars. This usually resolves quickly, but may persist for a few weeks. Major nerve or blood vessel injury is extremely uncommon. Blood clots in the legs and lungs are also extremely uncommon and usually do not require prophylactic medical therapy. Infection is very uncommon.
Repeat arthroscopy is uncommon, but if you require a meniscal repair at the time of surgery, up to 80% heal and 20% do not heal. Some of those that do not heal require repeat arthroscopy for related symptoms.
Re-rupture of the graft or uninjured ACL is 1% per knee per year. As you have proven to be the type of person who can rupture a native ACL, there is a chance that you may injure your other ACL as well as your reconstructed ACL. Performing ACL injury prevention exercises has been shown to reduce this risk in groups of athletes.
For more information, see the American Academy or Orthopaedic Surgeons website.
Contact our Gold Coast Practice
With 18 years of medical experience, Dr Agolley is an experienced and practiced knee surgeon who has performed many ACL reconstructions and is experienced in hip arthroscopy, hip replacement and the treatment of various sports injuries.
You can reach Dr Agolley at his practice in John Flynn Private Hospital on the Gold Coast. He consults and operates at the John Flynn and at Gold Coast Surgical Private Hospitals, and operates at The Tweed District Hospital and Murwillumbah District Hospital. To book a consultation or to speak to Dr Agolley, call 07 5598 0530.