ACL & Ligaments (ACL Reconstruction)

The anterior cruciate ligament is one of the most commonly injured ligaments
of the knee.

Signs of ACL damage include:

• A loud “pop” or a “popping” sensation in the knee
• Severe pain and inability to continue activity
• Swelling that begins within a few hours
• Loss of range of motion
• A feeling of instability or “giving way” with weight bearing.

What does surgery involve?

Thankfully surgical reconstruction is generally a very successful operation if done before any permanent chondral or meniscal damage occurs (Dr Herald will assess this with examination and imaging).

As ACL generally does not heal, the surgical reconstruction is performed using either the patient’s own tendon (auto graft form hamstring or patella tendon) or that of a cadaver’s (allograft).

The procedure is usually a day surgical procedure but the reconstructed ligament matures over a one year period so return to sport requires intensive rehab.

 OTHER LIGAMENT INJURIES

Posterior Cruciate Ligament Injuries

• The PCL is located at the back of the knee and stops the tibia moving backwards. It is less common to injure the PCL than other types of knee ligaments.
•  Impact injuries like dash boards of cars hitting the knee or hyper-extension injuries are the typical mechanisms of injury. The PCL injury may be categorised as a grade 1, 2 or 3 injury, where grade 3 is a complete rupture.
• Complete rupture presents with pain, swelling, instability and loss of range of motion. Surgical treatment may be advised if the patient wishes to return to a high level of function.

Collateral Ligament Injuries

• Collateral ligaments of the knee are the ligaments which brace the sides of the knee joint.
• There is the Medial Collateral Ligament (MCL) and the Lateral Collateral Ligament (LCL).
• As with other types of ligament tears, collateral ligament injuries are categorised as a grade 1, 2 or 3 injury, where grade 1 is slightly stretched and grade 3 is a complete tear or rupture.
• The MCL is more frequently damaged than the LCL due it being easier to create a valgus strain versus a varus strain. Pain, swelling and instability are the symptoms and typically immobilisaton without surgery is the recommended treatment.

Combined Knee Ligament Injuries

• Combined knee ligament injuries are complex injuries and an assessment of which ligaments have been affected and the recovery expectation of the patient need to be carefully considered. Multi ligament tears present with pain, swelling and inflammation. Treatment is often surgical and best soon after the injury.
• Arthrofibrosis or scar tissue of the joint is a risk factor to consider for surgery of these conditions.