A severe injury to the anterior cruciate ligament—such as a tear or rupture —causes sudden pain and swelling. It can cause reduced knee motion and can make the joint highly unstable. This kind of injury typically requires reconstruction of the ACL in order to regain normal function and avoid early arthritis.
The anterior cruciate ligament (ACL) is one of the four main ligaments in the knee. Along with the posterior cruciate ligament, the ACL controls the “back and forth” movement of the knee, and plays a very important role in stabilising the knee joint while allowing it the flexibility it needs to function.
ACL tears are one of the most common knee injuries, particularly for athletes in sports such as soccer and basketball. Most of the time, an ACL tear is the result of landing with force while the knee or ankle is pivoted. With sufficient force on impact, the ligament can be strained to the point of tearing.
While it's often athletes who sustain injuries to the ACL, they can happen to other people too. Any sufficiently forceful movement that puts stress on the ligament has a risk of injuring the ACL. The most common at-risk movements are things like rapid changes of direction, sudden stopping, incorrectly landing from a jump, or a tackle or other direct collision.
If the ACL is sprained, a course of treatment that includes rest, pain management, and physical therapy is typically enough to heal the tissue. However, if the ACL is torn, it's usually the case that surgery is required to reconstruct it. This is particularly true for patients who want to be able to return to sports.
Since the two ends of the ligament are not always possible to repair a surgical graft that uses tissue from elsewhere in the patient's body, is used to reconstruct the ACL. Certain patients may be suitable for cadeveric allograft, this reduces the donor site morbidity and often allows for a more rapidly d recovery. The graft used to repair the ACL is taken from the patient's hamstring tendon located at the back of the thigh, or from their patellar (kneecap) tendon, which connects the kneecap and tibia. Some patients may be suitable for a newer technique of ACL repair is they have an ACL avulsion and the injury has been dealt with promptly.
ACL reconstruction surgery is usually carried out with arthroscopic techniques, which is less invasive and has a faster recovery time.
During the surgery, small holes are drilled in the femur and tibia to allow the surgeon access to the ACL. The torn sections of ACL are removed via the holes in the bone. Next, the graft material is removed from either the patellar tendon or the hamstring ligament, and is used to reconstruct the ACL. Once the graft is in place, it's held in place with a suspension system and bio-absorbable screws.
Rehabilitation is important for everyone who has ACL surgery but it's particularly vital for athletes who want to return to active play, first to safely allow the joint to return to a full range of motion, and second to build up leg strength in order to protect the ligament from further damage. Strengthening work also focuses on the ligament itself, to build up the amount of stress it can withstand.
Using tissue from tendons as graft material does have some impact on the tendon that supplies the graft. With the hamstring graft, for example, the tissue that's used isn't from the primary hamstring, but from one of the accessory hamstrings. Even so, the hamstring is typically a little weaker after the surgery. Similarly, when a patellar tendon graft is used, there's an increased risk of patellar tendonitis, and kneeling can cause discomfort.
Other risks are stiffness, numbness, thrombosis and re rupture. However, would good post operative care and guided physio therapy these risks can be kept to a minimum.
I am writing to thanks you & your staff fro the wonderful work you did on my hip repllacement. It is so nice not to be in constant pain and it's enjoy able to go for a walk now & not dread it as before. I can't thank you + the staff at the cavell hospital enough.
After years of arthritic pain, steroid injections, physiotherapy and arthroscopy (which actually made things far worse)... I now feel like a new woman thanks to the knee surgery you performed last month - I have no doubt this is due in no small part to your skill as a surgeon. The wound healed quickly, recovery has been rapid, without any complications and the scar is neat and beautifully stitched!!
Having recently undergone a full left knee replacement I am 100% satisfied with everything Mr Saksena and his team at The Cavell provided. I was given plenty of advice both before and after my surgery, which was very reassuring. My recovery has been rapid with minimal pain and within 8 weeks I had full extension and 130 degree flexion back in the knee. I wouldn't hesitate to recommend Mr Saksena as an orthopaedic surgeon.
I had a total knee replacement with Valgus Deformity 7 weeks ago, and this gave the surgeon extra work to do, I only have good things to say about this surgery and after care with all staff involved at Chase Farm Hospital, as in my experience I have heard a lot of good and bad things about this type of surgery, Well I can only say that if anyone has concerns about this please try not to worry it is worth while as it has given me a new lease of life to what I had before, and yes the first 2 weeks are the worse, but please do try your exercises, because as they say you only get the real benefit if you are prepared to do your bit. Thanks very much for my new lease of life yet again.
I was very fortunate to be referred to Mr Saksena as an NHS patient and was very impressed with the treatment and care provided by Mr Saksena and the whole team at Cavell Hospital. Once discharged, someone was always available to talk to you and an appointment was made immediately if you needed to see a nurse (which I did several times, due to a normal discharge from my wound). The entire staff were all friendly, cheerful and efficient. The scar is very neat and after 7 weeks I am walking well and just using a stick outdoors.
I would like to just sincerely thank you for the job you did on my knees, both of them. Before I had my knees replaced I was in constant pain, which had been the case for nearly 5 years. It was so bad that I often wondered what the use was in living! Now, nearly 2 years later, I feel I have my life back. I can now walk without pain and every single day, and I mean every single day, I walk the roads that I walked pre-operations and I remember the pain that I was in for every small distance I had to walk. Now, I walk with a smile on my face and a thrill in my heart, so very grateful for having the freedom to enjoy walking once again. I also have great fun going with the grandchildren to the park and playing with them, which before the operation was impossible as all I could do was basically sit and supervise them. So there too there is a huge change.
You did a total knee replacement on my right leg on 22nd March in the Kings Oak Hospital and it has been very successful. I am now almost pain free with the knee getting stronger each day. I would like to thank you and your excellent medical team for doing such a neat job. I would also like to thank the wonderful nurses at the hospital who were always cheerful and efficient.
In September 2014 I underwent a knee replacement operation. Mr Saksensa was an amiable professional with a calming influence and caring nature. His team were friendly and supportive. My knee replacement was a complete success and I am still enjoying my favourite sport of skiing.
You performed a partial meniscectomy at Highgate Hospital in late april. I would like to thank you for your hardwork; the problem has been entirely resolved and I am pretty sure that is down to the procedure rather than the passage of time as the condition persisted during the prior two months. Some part of that is surely down to your skill.