ACL Reconstruction

Dr. David Colvin, orthopaedic surgeon in Perth. David's specialty is knee and shoulder surgery and sports injuries.

Repeated episodes of instability or a feeling of insecurity with your knee will prevent you from playing sport and enjoying life to the full.

The torn ACL shrinks to a stump and cannot be repaired. Treatment for an ACL tear requires ACL reconstruction. Your orthopaedic surgeon will make a new cruciate ligament using a graft. Once the graft has been taken, the surgery is done arthroscopically. This is minimally invasive and allows for a quicker recovery and less pain.

If you have had an injury where you felt a pop in the knee followed by swelling over the next twenty-four hours then you may have an ACL tear. Suspect an ACL injury if you have been through a rehab program with your physiotherapist and have ongoing symptoms of instability in the knee, giving way, or reinjury.

An anterior cruciate ligament tear may be associated with other injuries in the knee. Often, there is also a torn meniscus, or an injury to the joint surface. This can result in locking, jamming, or even a loose body within the knee joint.

Some patients with a longstanding ACL tear do not experience giving way but rather a vague sensation of not being able to trust the knee joint. In particular, they are wary about running activities that involve change of direction. A lack of trust in the security and stability of the knee can be an indication of a previous cruciate ligament tear that went undetected.

If this sounds like your knee you should be reviewed by an orthopaedic surgeon. Dr David Colvin is an experienced orthopaedic surgeon who has helped many Perth patients with ACL injuries. Dr Colvin can advise you on whether knee reconstruction surgery is required. He will discuss with you the best graft choices for your particular injury and your sporting requirements. 

There are several graft options to choose from for this surgery. Factors in graft choice include your age, sex, occupation, sport and previous injuries or surgery.

Hamstring tendons are the most popular choice for cruciate reconstruction. They form a strong graft, and because the graft is made up of your own tissue, it integrates quickly and permanently. Using a hamstring graft doesn't weaken the hamstring muscles.  

There are a number of alternative grafts:

• Patellar tendon graft: This method involves taking a strip of the middle third of the patellar tendon including a small piece of bone from the knee cap where the tendon starts and from the tibia where the tendon attaches.
• LARS graft: This is a synthetic ligament which is threaded through the stumps of the torn cruciate ligament. Cells from your cruciate ligament stump grow into the woven ligament which acts as a scaffold for a new ligament to form.

• Hybrid reconstruction or Augmented LARS reconstruction: In this method, the LARS graft is combined with a conventional hamstring graft in an attempt to achieve the best of both worlds. The LARS ligament provides immediate stability for quicker rehabilitation, and the hamstring tissue offers the basis for a long-term living ligament.

In the field of shoulder and knee reconstruction, successful outcomes from an operation are 50% surgery and 50% rehabilitation. You could say the surgery is the easy bit, the rehabilitation is all hard slog. Dr Colvin’s CO.RE exercise programs are just that, a core plan for your successful recovery.