Island Orthopaedic Consultants
Sports Medicine & Surgery
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-Knee -Ankle -Shoulder -Elbow -Hip -Wrist Anterior Cruciate Ligament Reconstruction Posterior Cruciate Ligament Reconstruction Arthroscopic Stabilisation Of The Unstable Shoulder Acromio-Clavicular Joint Arthritis Arthroscopic Rotator Cuff Repair |
Anterior
Cruciate Ligament Reconstruction In the pursuit of sporting
activities, it is not uncommon for many to sprain their knees. Most of these
sprains are minor and they recover fully after a short period of rest. If the
knee is still swollen, painful and limited in its ability to bend after a few
days or feels wobbly and unstable, it is likely that the knee has sustained
significant injuries which should be attended to. Soccer and basketball players
constitute the majority of patients who sustain serious damage their knee. This
is not surprising in view of the immense popularity of these sports as well as
the robust nature of the sport and the strain the knee is subjected to. Most
commonly, the anterior cruciate ligament is torn as a result.
The incidence of anterior cruciate ligament tear varies with age
and sex; younger athletes more often than older athletes and men more than
women. If you ask the afflicted, they may tell of a ‘pop’ sound during the
injury with the knee buckling and giving way. There is usually swelling of the
knee within the first few hours.
This injury can be debilitating because
the anterior cruciate ligament of the knee is an important stabiliser of the
knee, especially during pivoting manoeuvres like turning on the run, jumping,
accelerating and decelerating. The main problem of patients with anterior
cruciate ligament deficiency is the unpleasant sensation of the knee giving way,
causing much inconveniences in the simplest of everyday tasks. Some of these
patients regain sufficient control of their knees after physical therapy to
manage at a reasonable level of activity. However, a significant proportion of
these ACL-deficient knees give way often enough and at the slightest provocation
that the patient often feels incapacitated, unable to enjoy doing the things the
used to and want to do. Apart from the physical incapacity, the frequent giving
way of the knees may damage the meniscus and joint surface which will result in
degenerative changes in the joint. These are reasons to advice these patients to
reconstruct the torn ACL and stabilise the knee. ACL reconstruction is one of the most
common operations performed by the orthopaedic surgeon. Restoration
of knee stability and return to activity can generally be expected in
the majority of patients after such a procedure. The patellar tendon
graft has been considered the ideal graft choice. It has
good structural and fixation properties, a potential for bone-to-bone
healing, and a predictable success rate in the restoration of knee
stability. However, donor-site problems have been reported after harvest of
patellar tendon grafts. Anterior knee pain, loss of sensation, patellar
fracture and loss of extension strength impair knee function in spite
of a successful replacement of the ACL. Therefore, use of the hamstring
tendon graft has increased in popularity as its use incurs fewer donor-site
complications. The structural strength of a hamstring tendon graft is superior
to that of a 10-mm patellar tendon-bone graft. The trend toward increased
popularity of the hamstring tendon graft is also related to the
development of fixation techniques better than those previously used
compared with those used for fixation of the patellar tendon graft.
Good post-operative care and an aggressive and
accelerated physiotherapy program is essential to ensure the patient has a
stable and pain-free knee which will enable him to return to the activity he
enjoys.
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