ACL RECONSTRUCTION SURGERY

I have a specialist interest in ACL injuries and their treatment. My surgical technique allows a rapid and accelerated rehabilitation programme. I have published a number of key research areas helping athletes return to sport successfully.
Surgery is an important part of the process but the pre-operative optimisation and post-operative rehabilitation and the team that surround you are also vital.

Surgical steps

The damaged intra-articular ACL is removed and reconstructed with a graft.
This is combined with a knee arthroscopy to guide the procedure and allow any other associated injuries in the knee to be treated at the same time, such as meniscal or cartilage damage
The graft is made by taking a section of tissue from around the knee, most commonly a hamstring tendon from the back inside of the knee or a strip of patella tendon from the front
My primary graft is a 4-strand semi-tendinosis hamstring graft that is pre-tensioned. It is a short stiff graft that has less chance of stretching over time
Bone sockets hold the intra-articular graft in place with a 360 degree bone contact for healing.
The graft is tensioned within the sockets using adjustable suspension with permanent buttons that sit snug onto the outside of the bone.
The graft is tensioned in the position of your normal knee extension (or hyper-extension) so there will be no issues achieving this range of motion post-op
The knee is meticulously washed out as even a tiny retained bone fragment from can cause inflammation and prolonged knee swelling
This may need to be combined with a second reconstruction on the outside of the knee for added control of knee stability
I use tranexamic acid (TXA), a medication proven to reduce swelling

Rehabilitation

My surgical technique allows rapid rehabilitation with very few significant restrictions. No brace. Crutches for comfort only.
The early aims are to minimise swelling, regain early full range of knee motion, and prevent any muscle loss.
Swelling can be a major issue so regular high elevation, cryotherapy (icing), and lower-leg muscle activation is required
I work with the best local physiotherapists and allow rehabilitation that is accelerated and matched to your performance levels
See the ACL REHAB section!
Review my insights in a talk on this subject uploaded in the BLOG

Other knee ligament repairs and reconstructions

Whilst the ACL is the most commonly injured knee ligament that requires surgery, there are 3 other main regions of the knee that can sustain ligament injuries:
- Medial collateral ligament (MCL)
- Lateral collateral ligament (LCL) and the posterolateral corner (PLC)
- Posterior cruciate ligament (PCL)
These ligaments can be injured individually or in combined multi-ligament injuries where each individual case has a tailor-made approach to repairing and reconstructing the knee

REVISION ACL RECONSTRUCTION

I am often sent referrals where a previous ACL reconstruction has failed, and asked to perform a revision or ‘re-do’ procedure
There can be a number of reasons for a ruptured graft such as a return to sport too early, a failure to provide an environment for graft healing and integration, graft malpositioning, or simply another episode of sufficient force during sport
It is vital that the revision reconstruction learns from any previous mistakes and that the surgery provides maximum stability to allow bespoke physiotherapy
3D imaging and weight-bearing full leg x-rays will help guide my surgery where I often offer different graft choices and always add in a lateral tenodesis
Post-op physiotherapy can often be the same fast protocols as seen in primary ACL reconstruction
A slope changing osteotomy; where there is ACL deficiency or a failed ACL reconstruction due to an increase in the slope at the top of the tibia. The increased postrior slope puts more pressure on the ACL