ACL Reconstruction A Highly Successful Surgery
ACL (anterior cruciate ligament) reconstruction is one of the most common post surgical rehabilitation programs that physios play an active role in, and in my opinion it is a surgery which typically has a high success and low complication rate.
Surgery trends exist just as fashion trends do, however thankfully as a rule surgical trends are based soundly on research and are as a result as the medical industry quest to achieve better and better outcomes combined with fewer complications.
ACL reconstruction is a surgery that eliminates symptomatic instability of the knee for most, and certainly in my experience it is generally considered a successful operation by patients choosing to undergo reconstruction.
ACL Reconstruction Using “Anatomical” Positioning
ACL reconstruction has been routinely performed as a arthroscopic surgery for some time now and the current trends at the moment with performing an ACL reconstruction is using the “anatomical” insertion point for the ACL, meaning the graft is secured in the original position of the failed ACL.
The positives around using an “anatomical” insertion point for the ACL are:
The new graft ACL more closely reproduces both bundles of the original failed ACL more so than using a “non- anatomical” positioning reconstruction
Resulting in improved stability in the knee.
The negatives around using an “anatomical” insertion point are:
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 patients undergoing this surgical technique may require slightly longer rehabilitation and return to sport time frames after “anatomical” ACL reconstruction, being progressed more slowly than after traditional, non-anatomic ACL reconstruction.
The Return Of The Patella Tendon Graft
Also trending is a return in popularity in the use of a patella tendon or quadrecip tendon grafts, the majority of grafts for the past 10 years or so I have been seeing in Sydney were typically hamstring grafts and I am now starting to see a few more patella tendon grafts again as was the trend way back in the late 90’s when I was working in back New Zealand.
The pros of using a patella tendon graft over a hamstring graft are:
It tends to be a stiffer graft using the patella tendon.
This may make it a better option in females who have tendency to be more flexible, where using a hamstring graft may carry with it the risk of more laxity and ending up a less stiff graft due to properties of the tendon graft stretching more in this population. Hence some people may respond better to a patella tendon graft.
Cons around using a patella tendon graft are:
Some patients report problems post surgically with jumping and kneeling as well as reports of anterior knee pain for some people.
Individual Circumstances Dictate Surgical Appropriateness
The decision to undergo an ACL reconstruction and the technique most suitable for you is something that should be discussed with your chosen surgeon. It is not by any means mandatory you have an ACL reconstruction simply because you have ruptured your ACL it always depends on individual circumstances. However as I said previously, in my experience it is a very successful surgery with very few complications and I have no hesitation in supporting the decision of any appropriate ACL reconstruction candidates when they elect to have the surgery.
Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance on ACL Reconstruction should consult his or her orthopaedic surgeon, general practitioner or physiotherapist.