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Anterior cruciate ligament (ACL) reconstruction

Three surgical techniques are used to treat ACL knee injuries:

  • Reconstruction using tendons from semitendinosus (ST) and gracilis (GR) tissues
  • Reconstruction using the patellar tendon
  • Reconstruction using an allograft (donor tendon)

Reconstruction with semitendinous, or gracilis tissues are now the most commonly used options. These surgeries involve the use of two medial flexor muscles from the thigh, which are then passed through a bone tunnel into the joint, usually arthroscopically. The time it takes these flexor muscles to heal after surgery is important to consider during the rehabilitation process.

Reconstruction using the patellar tendon involves the removal of the central third of the patellar tendon through an incision, approximately 5 cm in length. This tendon is then inserted into the joint through a bone tunnel using arthroscopic guidance. This type of intervention tends to weaken the extensor apparatus of the knee which can lead to painful tendinopathy of the quadriceps and patellar tendon if excessive load is used during rehabilitation - therefore increasing the recovery time and making it a less popular option.

Reconstruction with an allograft is a graft obtained from a donor Achilles, or patellar tendon. This intervention has the advantage that tendons are not taken from the patient, avoiding the weakening of the thigh or quadriceps flexor muscles as in the two previous interventions.

Use of a brace to immobilise the knee after surgery is at the discretion of the orthopaedic team. In most cases, the use of crutches is suggested for around 3 weeks.

Rehabilitation should begin two days after the surgery, either in hospital or at home, before starting at our centre around ten days later. Rehabilitation from these kinds of surgery can take up to five months, with activity alternating between aquatherapy, physiotherapy, and on-field rehab.

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