Anterior Cruciate Ligament Reconstruction
Indications for reconstruction of the ACL
If you have had a twisting injury to your knee, associated with a large swelling of the knee within an hour or so then it is likely that you have damaged your anterior cruciate ligament.
If you are now finding that you canot get back to your normal sport or work because your knee feels unstable, loose or as if it wants to 'dislocate' then you may benefit from a reconstruction of the ACL ligament.
For more information visit the American Academy site by clicking on the button below
If you are now finding that you canot get back to your normal sport or work because your knee feels unstable, loose or as if it wants to 'dislocate' then you may benefit from a reconstruction of the ACL ligament.
For more information visit the American Academy site by clicking on the button below
Please be aware that the following refers to the techniques employed by Mr Hamlet and may differ with other surgeons
PROCEDURE:
The Anterior cruciate is a ligament that runs inside the knee from the thigh bone to the shin bone giving stability to the knee joint. Loss or damage of the ligament can make the knee more prone to ‘giving way’. Your ACL has torn (ruptured).
You may have come to a joint decision with your surgeon to attempt a reconstruction.
Unfortunately, once this ligament has torn, it cannot usually be repaired. As a result, a new ligament must be made from elsewhere (a graft).
You will be seen by the surgeon on the day of the operation. The surgeon will take the opportunity to mark your leg with a felt pen. This is to ensure the correct leg will be operated on. If you have any questions, now is a good time to ask them.
An anaesthetic will be administered in theatre. This is usually a general anaesthetic (where you will be asleep) with a local block. You may have a regional block (i.e. where you are awake but the area to be operated is completely numbed). You may discuss this and the risks with the anaesthetist.
Mr Hamlet does not use a tight inflatable band (tourniquet) around your thigh although other surgeons may do so.This means that you have no thigh pain after the operation
During the operation, You will have a telescope examination of your knee (an arthroscopy). Small cuts are made through skin which has been cleaned by antiseptic solution. The cuts are usually no bigger than 1cm and made either side of the knee cap. A telescope with a camera at the end (less than the width of a pencil) can look into the knee and shows a picture on a nearby television screen.
The surgeon will introduce other instruments through the second cut. Any “tidying up” of any other structures can be done at this point (such as smoothing cartilage).
A graft also needs to be taken. There are a few methods and types of graft available.
The two common techniques used are either taking a tendon from the hamstring muscles ( the preferred technique for Mr Hamlet) or using part of the ligament that runs from the kneecap to the shin bone (patellar-tendon graft). Both involve making cuts in the skin in front of the knee.
Tunnels are drilled which allow the graft to pass through the knee joint. This graft is then held into position at both ends by screws, pins or slings. It is important to get the right tension on the ligament as it is fixed.
If there is increased laxity of the capsule on the outer side of the knee then an augmentation to the antero-lateral ligament (ALL) may be done. This involves two more small incisions, a synthetic strip of ligament and non metallic screws to hold it in the bones
The open skin is then closed with nylon stitches .
You will wake up in the recovery room with a bandage around the knee.
You may feel sore. This is normal. However, if the pain is intolerable, it is very important you tell the nursing staff.
When you are feeling well enough, and you have been shown how to walk (with or without crutches,) you will be allowed to go home. This is usually on the day of operation .
You can weight bear normally as soon as you feel able.
You will more than likely be introduced to a rehabilitation (physio) program. It is very important you attend this strictly.
***Be assured that, as a private patient of Mr Hamlet's you will always have the operation performed by him personally***
ALTERNATIVE PROCEDURE:
Some patients simply avoid activities that cause their knees to be unstable.
Physiotherapy and increasing strength of hamstrings and quadriceps may be able to compensate for the injury. The knee may still however be prone to ‘giving way’ and instability.
The decision to proceed to a reconstruction should be a joint one between yourself and the surgeon.
There are also alternative methods of reconstruction and numerous grafts that can be used. You should discuss the options with your surgeon beforehand.
RISKS
As with all procedures, this carries some risks and complications.
COMMON (2-5%)
Pain: the knee will be painful after the procedure. Pain killers
(Analgesics) will be given to prevent this including enough to go home with.
Numbness: the skin around the knee or shin may be temporarily or more
permanently numb due to damage of small nerves.
Swelling/ Haemarthrosis: This is a collection of fluid or less commonly, blood in the knee joint. In most cases, the body will absorb the fluid itself. If the swelling becomes too large, the surgeon may feel an operation is necessary.
Stiffness: you may have difficulty in straightening your knee or squatting.
Persistent pain: pain may persist after the procedure. A repeat arthroscopy or other knee operation may be required.
Continued instability: weakness and instability may occur despite adequate surgery
LESS COMMON (1-2%)
Infection: the wound sites may become red, painful and hot. There may also be a discharge. These are signs of infection and can usually be treated by antibiotics. The infection may spread to the knee joint itself (requiring a washout) and removal of the graft. Infection may also spread to the blood (sepsis) requiring intravenous antibiotics.
Graft rupture: (torn graft) this may occur after further trauma. Further surgery may be necessary.
RARE (<1%)
Damage to structures within the knee: this is rare, but may cause further damage and symptoms. This may need further treatment including operation. These
include fractured knee cap (patella) if a patellar tendon graft is used.
Damaged instruments: these may break within the knee and require an opening of the joint to remove them.
Abnormal wound healing: the scar may become thick, red and painful (keloid scar). This is more common in Afro-Caribbeans. There may also be delayed
wound healing for numerous reasons.
Compartment syndrome: this is a build up pressure within the lower leg and can cause nerve damage, blood vessel damage and muscle damage. If this
occurs, an emergency operation will have to be performed to prevent death of tissue of the lower leg/ foot.
Osteoarthritis: this can be more common after joint operations.
PROCEDURE:
The Anterior cruciate is a ligament that runs inside the knee from the thigh bone to the shin bone giving stability to the knee joint. Loss or damage of the ligament can make the knee more prone to ‘giving way’. Your ACL has torn (ruptured).
You may have come to a joint decision with your surgeon to attempt a reconstruction.
Unfortunately, once this ligament has torn, it cannot usually be repaired. As a result, a new ligament must be made from elsewhere (a graft).
You will be seen by the surgeon on the day of the operation. The surgeon will take the opportunity to mark your leg with a felt pen. This is to ensure the correct leg will be operated on. If you have any questions, now is a good time to ask them.
An anaesthetic will be administered in theatre. This is usually a general anaesthetic (where you will be asleep) with a local block. You may have a regional block (i.e. where you are awake but the area to be operated is completely numbed). You may discuss this and the risks with the anaesthetist.
Mr Hamlet does not use a tight inflatable band (tourniquet) around your thigh although other surgeons may do so.This means that you have no thigh pain after the operation
During the operation, You will have a telescope examination of your knee (an arthroscopy). Small cuts are made through skin which has been cleaned by antiseptic solution. The cuts are usually no bigger than 1cm and made either side of the knee cap. A telescope with a camera at the end (less than the width of a pencil) can look into the knee and shows a picture on a nearby television screen.
The surgeon will introduce other instruments through the second cut. Any “tidying up” of any other structures can be done at this point (such as smoothing cartilage).
A graft also needs to be taken. There are a few methods and types of graft available.
The two common techniques used are either taking a tendon from the hamstring muscles ( the preferred technique for Mr Hamlet) or using part of the ligament that runs from the kneecap to the shin bone (patellar-tendon graft). Both involve making cuts in the skin in front of the knee.
Tunnels are drilled which allow the graft to pass through the knee joint. This graft is then held into position at both ends by screws, pins or slings. It is important to get the right tension on the ligament as it is fixed.
If there is increased laxity of the capsule on the outer side of the knee then an augmentation to the antero-lateral ligament (ALL) may be done. This involves two more small incisions, a synthetic strip of ligament and non metallic screws to hold it in the bones
The open skin is then closed with nylon stitches .
You will wake up in the recovery room with a bandage around the knee.
You may feel sore. This is normal. However, if the pain is intolerable, it is very important you tell the nursing staff.
When you are feeling well enough, and you have been shown how to walk (with or without crutches,) you will be allowed to go home. This is usually on the day of operation .
You can weight bear normally as soon as you feel able.
You will more than likely be introduced to a rehabilitation (physio) program. It is very important you attend this strictly.
***Be assured that, as a private patient of Mr Hamlet's you will always have the operation performed by him personally***
ALTERNATIVE PROCEDURE:
Some patients simply avoid activities that cause their knees to be unstable.
Physiotherapy and increasing strength of hamstrings and quadriceps may be able to compensate for the injury. The knee may still however be prone to ‘giving way’ and instability.
The decision to proceed to a reconstruction should be a joint one between yourself and the surgeon.
There are also alternative methods of reconstruction and numerous grafts that can be used. You should discuss the options with your surgeon beforehand.
RISKS
As with all procedures, this carries some risks and complications.
COMMON (2-5%)
Pain: the knee will be painful after the procedure. Pain killers
(Analgesics) will be given to prevent this including enough to go home with.
Numbness: the skin around the knee or shin may be temporarily or more
permanently numb due to damage of small nerves.
Swelling/ Haemarthrosis: This is a collection of fluid or less commonly, blood in the knee joint. In most cases, the body will absorb the fluid itself. If the swelling becomes too large, the surgeon may feel an operation is necessary.
Stiffness: you may have difficulty in straightening your knee or squatting.
Persistent pain: pain may persist after the procedure. A repeat arthroscopy or other knee operation may be required.
Continued instability: weakness and instability may occur despite adequate surgery
LESS COMMON (1-2%)
Infection: the wound sites may become red, painful and hot. There may also be a discharge. These are signs of infection and can usually be treated by antibiotics. The infection may spread to the knee joint itself (requiring a washout) and removal of the graft. Infection may also spread to the blood (sepsis) requiring intravenous antibiotics.
Graft rupture: (torn graft) this may occur after further trauma. Further surgery may be necessary.
RARE (<1%)
Damage to structures within the knee: this is rare, but may cause further damage and symptoms. This may need further treatment including operation. These
include fractured knee cap (patella) if a patellar tendon graft is used.
Damaged instruments: these may break within the knee and require an opening of the joint to remove them.
Abnormal wound healing: the scar may become thick, red and painful (keloid scar). This is more common in Afro-Caribbeans. There may also be delayed
wound healing for numerous reasons.
Compartment syndrome: this is a build up pressure within the lower leg and can cause nerve damage, blood vessel damage and muscle damage. If this
occurs, an emergency operation will have to be performed to prevent death of tissue of the lower leg/ foot.
Osteoarthritis: this can be more common after joint operations.
