Anterior Cruciate Ligament Reconstruction (ACL)
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ACL reconstruction in Melbourne is a commonly performed procedure to reconstruct the anterior cruciate ligament. This can be done in a variety of ways, with both keyhole and open surgery being possible to reconstruct the ACL. Overall it has excellent results in terms of stability, pain reduction, and return to sports and activities.
Reasons for ACL Reconstruction in Melbourne
ACL reconstruction is a procedure that replaces the anterior cruciate ligament, a major ligament in your knee, if it is torn. These injuries usually happen during sport. While some can recover from a torn ACL with rest and physiotherapy, surgery is recommended for others, including:
- Athletes who want to continue practising their sport
- Injuries where more than one ligament has been injured
- Someone that needs a torn meniscus surgery
- Injuries that cause your knees to buckle during everyday activities
If any of those apply to you, you should consider getting ACL surgery in Melbourne.
ACL Surgery Procedure Description
ACL reconstruction surgery involves taking a donor tendon and re-creating the ACL. This normally involves taking a ‘spare’ tendon or ligament around the knee, and then using this as a graft.
Typical donor grafts include:
Hamstring tendons
Quadricep tendon
Patella Tendon
Donated Tendons
Synthetic tendons (eg Lars® ligaments)
Sometimes a combination of these may be utilised to ensure that your knee is as solid as possible.
Two tunnels in the tibia and the femur are then created and the graft is tensioned and secured in place. This is normally done with either specialised screws, buttons or fixation devices (see X ray below). These normally remain inside the knee.
The procedure normally takes 1-2hrs, and it is conducted under a general anaesthetic.
Additional procedures may be undertaken in the same anaesthetic to fix other issues that can commonly occur at the same time as an ACL injury, for example meniscal tears and cartilage lesions.
Risks of ACL Reconstruction Surgery in Melbourne
There are risks with surgery. These include infection, knee pain and stiffness, graft rupture and failure to get back to high level sport. Arthritis may occur in the future as a result of the damage caused by the injury. The risks of surgery can be reduced by choosing an experienced and reputable ACL surgeon in Melbourne that you know you can trust.
ACL Reconstruction Pre Operative Information
ACL reconstruction is a major knee surgery procedure, and it is essential that you are adequately prepared for your procedure.
Prior to your surgery, it is recommended that you see a physiotherapist to improve your strength, range of motion and stability, so that your rehabilitation and recovery from your surgery is as quick as possible. It is essential that you have a good range of motion prior to undergoing an ACL reconstruction surgery so that your knee recovers its full range of motion after the surgery.
What Happens During ACL Reconstruction Surgery?
ACL reconstruction is usually done under general anaesthesia, which means you will be unconscious for the procedure. There are different ways to perform the surgery, but usually, your ACL surgeon will make small incisions. In one incision there will be a camera attached to a tube, which will provide your ACL surgeon in Melbourne with vision over the ligament. The other incisions allow the surgical instruments to access the area.
During surgery, the damaged ligament is removed and replaced with a graft from you or a donor. Sockets or tunnels are drilled into the thighbone to attach this replacement graft, and the graft is then secured to the bone. New ligament tissue will then grow on this graft.
Post Operative Information About ACL Reconstruction in Melbourne
What to expect after surgery
You will stay in the hospital overnight following your surgery. You can be discharged the next day with pain relief.
You will have a dressing on your surgery site and a bandage which needs to stay clean and dry for 14 days. If additional procedures (eg meniscal repair) are undertaken, you may require a brace, however normally no brace is required. You will require crutches normally for 1-2 weeks after surgery.
You can move your feet and hip straight away, but the dressing on the knee will prevent it from moving too much. It is a good idea to keep moving even after your surgery, it helps your blood circulation and stops your body getting too weak. Avoid any strenuous activity for the first 2 weeks, but gentle walking and exercise is helpful.
After 2 weeks you will have an appointment with to have your wound checked, any stitches will be removed.
If you have any of these problems, please contact us on 03 5752 5020 or 1300 266 356
Fever
Heavy bleeding or ooze from the wound
Increased swelling and redness around the surgery site
Pain in the calf muscles or difficulty breathing
Consult the Experts in Anterior Cruciate Ligament Reconstruction in Melbourne
Damaging your ACL can not only be extremely painful, but it can also limit your mobility and ability to go about your daily life. Don’t suffer in silence. Help is simply a phone call away. Contact us here at Victorian Bone & Joint Specialists; we really are experts in ACL reconstruction in Melbourne.
You’ll find a team of highly-trained specialists at our modern clinic in Fitzroy who utilise the latest, cutting-edge surgical innovations, equipment and techniques to ensure optimal recovery and minimal downtime. ACL reconstruction is not without its risks, so it pays to have an expert on your side. You’ll find such experts here at Victorian Bone & Joint Specialists.
Diagnosing and treating damage to anterior cruciate ligaments is all in a day’s work for us. We have the experience and the expertise to carry out surgery of this type with great skill to deliver the best outcomes for our patients.
If you have an issue with your ACL or you need a second opinion about potential ACL reconstruction in Melbourne, get in touch and we can arrange an appointment with one of our fellowship-certified orthopaedic specialists.
FAQs
Do I require ACL reconstruction surgery by an orthopaedic surgeon in East Melbourne?
If you have an ACL rupture, and instability of your knee, then it is likely that you will require an ACL reconstruction. Similarly, if you wish to get back to high level pivoting sports and you have an ACL rupture, it is generally recommended to Consult with an ACL surgeon in Melbourne.
What are the results of ACL reconstruction surgery?
Can I play sports after ACL reconstruction surgery?
Most people are able to get back to sports after an ACL reconstruction, however, approximately 30% of patients may not get back to elite/high level sports, if they were prior to the procedure.
When can I return to work after ACL reconstruction surgery?
This depends upon the type of work you are doing. You should be able to return to office or desk based duties approximately a week after surgery, however, heavy manual activities take at least 6 weeks to return to.
When can I drive after ACL reconstruction surgery?
If you have knee replacement surgery or an ACL reconstruction on your left knee, once you are off strong pain relief, typically 2-5 days post op, you are able to drive. If it is your right knee, it will depend upon the strength within you knee. This typically takes 3-4 weeks.
What are the different types of ACL reconstruction surgery?
There are various different types of ACL surgery in Melbourne, and many different techniques which have been described in the literature including single bundle, double bundle, intra-articular, extra-articular, and many different graft choices. Your orthopaedic surgeon at VBJS will discuss the best option for you during your consultation, and your particular needs as there are risks and benefits of each different technique.
What is the best graft for ACL reconstruction surgery?
This is very difficult to determine, and there is much debate among knee surgeons in Melbourne, however, the most commonly utilised grafts include hamstring grafts, patella tendon grafts and quadriceps grafts. There is no one ‘best’ graft, as there are pros and cons of each.
Is the Quadricep tendon graft the best for ACL reconstruction surgery?
No, as detailed above there are many considerations in selecting a graft, and there is ‘no one size fits all. Whilst the quadriep tendon graft has some advantages, it needs to be carefully considered.
How do I get ACL reconstruction surgery in Melbourne?
If you have a ruptured ACL and you want to get ACL reconstruction in Melbourne, your first step is to discuss this with your GP. They will refer you to an orthopaedic surgeon that will be able to determine if you're a candidate for surgery and then perform the procedure.
What are the results of ACL reconstruction surgery in Melbourne?
The results of ACL reconstruction surgery are generally very good with most patients being able to get back into high level sports. There is a risk of re-rupture of the ACL which is between 5-15%, and there is also a significant risk of injuring your opposite knee. The risk of re rupture depends upon your age, gender, underlying ligament laxity and your anatomy.
ACL Surgery Post Operative Rehabilitation Protocol
Phase 1 (Week 1-2): Swelling Reduction, Pain Control, Quadriceps Activation
Aims: Reduce Swelling, Control Pain, Regain Quads Control
Weight Bearing as tolerated
Compression + Cryotherapy (Cold Packs/Active Fluid cooling): reduce haemarthrosis and swelling
Ankle Exercises: for DVT prophylaxis
Crutches for ambulation (weight bearing as tolerated) – aim to discontinue by week 1-2
Quadriceps Activation: straight leg raises
ROM: full extension to maximal pain free flexion
Phase 2 (Week 3-6): Range of Motion and Strengthening
Aims: obtain full ROM, reduce swelling and pain, early muscle retraining
Swelling control: compression and cryotherapy to continue as required
Range of Motion:
Passive Stretches 4-5 x per day to obtain maximal ROM
Maximal flexion as tolerated with stretches
Gait: work on normalizing gait pattern
Gentle proprioception activities
Swimming with pool buoy
Gentle exercise bike
NO Hamstrings strengthening/resistance
Phase 3 (Week 6-12): Neuromuscular Retraining and Strengthening
Aims: maintain full knee ROM, improve strength, enhance proprioception, balance and control, improve muscular endurance and confidence
Range of Motion: Restoration of Full ROM
Straight Line Running: Week 6
Perturbation Challenges/Training: Patient on rocker board challenged with instability by Physiotherapist
Strengthening Exercises:
Walking normally but not for exercise
Quadriceps
Cycling with progressive resistance
Wean off pool buoy from 8 weeks
Commence hamstrings strengthening at 8 weeks
Phase 4 (3-6 months): Advanced Retraining
Goals: enhance neuromuscular control, normalise muscle strength, perform selective sports specific drills + agility training
Continue previous neuromuscular exercises
Plyometrics from 3 months
Running: gentle proprioception drills (4 months), agility drills (5 months)
Side stepping, lateral movements
Phase 5 (6-9 months): Sport Specific Retraining
Work on sport specific training and drills
Practice FIFA 11 warm up injury prevention
Phase 6 (9+ months): Sport Recommencement
Ease into sports
Do not play unless confident
FIFA 11 warm up
If at any time there is increasing pain, catching or locking within the knee please contact us.
