ACL Reconstruction Trends

ACL Reconstruction Is A Highly Successful Surgery

Anterior cruciate ligament (ACL) reconstruction surgery is a very common elective surgery in Australia and from a physiotherapy perspective are one of the most common post surgical rehabilitation programs that physiotherapists play an active role in. In my experience an ACL reconstruction is a surgery which has a high success and typically a relatively low complication rate, this obviously depends on how you classify and measure success. From a patient perspective success may be classified as a return to sport at their pre-injury level or it may simply be a return of confidence in their knee within its capacity to perform their normal daily functions, or perhaps success is something that can only be measured down the track as a full functioning pain free knee deep into their twilight years… Whatever the athlete decides to use as their measure of success in my experience an ACL reconstruction followed with appropriate post surgical rehabilitation typically provides a great platform to help them achieve their chosen success. However given it isn’t the only treatment approach available following ACL rupture these decisions made in consultation with your doctor, surgeon, physio are always individualized and ultimately are made by the athlete themselves.

Just as there are fashion trends, surgery undergoes trends as well. However to say that is doing surgery and surgeons a great disservice, as the trends in surgery don’t exist as they do in fashion where trends occur sometimes “just because”. Thankfully, surgical trends are generally based on sound research and arise as a result of the medical industries quest to progressively achieve better outcomes, combined with fewer complications. An ACL reconstruction is a surgical procedure that aims to eliminate symptomatic instability of the knee, and for most part and certainly in my experience it is generally considered a successful operation in achieving this goal. Ultimately successful elimination of symptomatic instability is highlighted by patients who have chosen to undergo an ACL reconstruction are able to return to their previous chosen activities around the one year post operative mark and the majority of the patients I assist with this process are able to achieve this.

Some Of The Trends In ACL Reconstruction Surgery

“Anatomical” Positioning – An ACL reconstruction has been routinely performed as a arthroscopic surgery for some time now and one of the more current trends is utilizing the “anatomical” insertion point for the ACL. This refers to the process of securing the graft in the original position of the failed ACL.
Pros and Cons Around “anatomical” insertion point Of ACL Grafts:

• Pros – The new ACL graft more closely mimics both bundles of the original failed ACL more so, than using “non- anatomical” positioning reconstruction techniques. Supposedly, resulting in improved stability in the knee.
• Cons – Some research has shown a higher re-rupture rate in professional soccer players returning to sport at 6 months post surgery when using an “anatomical” insertion point. So, it could be hypothesized patients undergoing this surgical technique may necessitate slightly longer rehabilitation with longer return to sport time frames following an “anatomical” ACL reconstruction. Taking care to progress the return to sport rehab phase more slowly than when following a traditional, non-anatomic ACL reconstruction surgery.

Patella Tendon Grafts Are Making A Comeback – There is also a rise in popularity of the use of patella tendon grafts. The majority of grafts for the past 10-15 years or so that I have seen in my Sydney physio practice have typically been hamstring grafts. However, I am now beginning to see a few more patella tendon grafts again.  Patella tendon grafting was the trend way back in the late 90’s when I was working in New Zealand at this stage the bulk of what we saw coming through were patella tendon graft ACL reconstructions.

• Pros – Utilising a patella tendon verses a hamstring tendon graft tends to result in a stiffer graft. Such difference potentially may make a patella tendon graft a suitable option in females who stereo-typically have tendency to be more flexible. Using a hamstring graft in the very flexible population may carry with it the risk of finishing up with a less stiff graft. This is due to properties of the hamstring tendon graft stretching more in this population, which with a patella tendon graft it is less likely to have this issue.
• Cons – Anterior knee pain can be a common post surgical complaint with people undergoing a patella tendon graft. With some patients reporting problems with post-surgical pain felt at the front of the knee when jumping and kneeling.

Individual Circumstances Will Ultimately Dictate Chosen ACL Surgical Techniques

The decision to undergo an ACL reconstruction and the technique deemed most suitable, is something that should be discussed with your chosen surgeon. It is important to note that it is not by any means mandatory you have an ACL reconstruction simply because you have ruptured your ACL. This decision depends on specific individual circumstances, however as previously mentioned, in my experience as a Sydney physiotherapist an ACL reconstruction is a very successful surgery with few complications. As a result I typically have limited hesitations in supporting the decision for my patients to undergo an ACL reconstruction.

Disclaimer: This information is provided as an educational service and is not intended to serve as a substitute for personalized medical advice. Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned in this post. Anyone seeking specific advice, or assistance regarding a “ACL Reconstruction” should consult his, or her physiotherapist, orthopaedic surgeon, general practitioner, sports medicine specialist, or otherwise appropriately skilled medical practitioner.