Reconstruction
Anterior Cruciate Ligament (ACL)
The anterior cruciate ligament (ACL) is the main stabilising ligament on the inside of the knee. Its main function is to prevent the tibia (shin bone) from sliding forward and rotating on the femur (thigh bone). Tears/ruptures of the ligament result in knee instability.
Causes
ACL tears are typically caused by twisting or hyperextension injuries. Sports activity like pivoting or sudden deceleration when running and falls during skiing are considered non-contact causes of ACL tears. Direct trauma to the back or side of the knee during collision sports is considered a contact injury to the ACL.
Symptoms
ACL tears cause immediate pain and often swelling. You may feel something “pop” inside the knee. An initial inability to bear weight on the leg may subside and walk may be possible after several minutes. The knee may feel loose or that it is going to “give out” and return to sport is impossible. Over time, swelling will increase, and motion may be lost.
Diagnosis
Your surgeon will perform a thorough history and physical exam with X-rays. On exam, swelling and loss of motion and strength are present. Your surgeon will perform manoeuvres to check the stability of all the knee ligaments and the meniscus. An MRI is helpful to confirm the diagnosis, showing the ACL tear. The type of tear (partial, complete, avulsion from either the tibia or femur) can be defined, which may assist in surgical planning. The MRI may also show bruising bone secondary to the injury.
Treatment
Non-operative
ACL tears do not heal. Some patients elect not to have reconstruction surgery. Non-operative treatment increases the risk of “wear and tear” arthritis and meniscus tears because of the joint's instability. Non-operative treatment consisting of anti-inflammatory medication, physical therapy, cryotherapy, and activity modification may be prescribed before surgery to decrease the swelling and regain motion and strength. Research has demonstrated that surgery is less complicated, and patients have better outcomes. Non-operative treatment is a surgical patient may be skipped if other injuries to the meniscus and cartilage are present and need to be repaired immediately.
Operative
Operative management of ACL tears depends on the type of tear. ACL repair may be indicated in patients where the ACL is torn off the femur wall (thigh bone) or tibia (shin bone. ACL repair is accomplished through a minimally-invasive arthroscopic procedure and sewed back into place and fixed with screws or buttons. The repair may also be supplemented with high-strength suture. If formal reconstruction is required, a new ACL graft will be fixed in place of the original ligament. A technique for graft placement and graft choice is a shared decision between you and your surgeon. Most techniques are performed through a minimally-invasive arthroscopic procedure. The graft can be taken from around your knee or from a donor. Postoperative rehabilitation, return to daily activities and return to sport depends on the technique and graft chosen, and is at your surgeon’s discretion.
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Reconstruction
Posterior Cruciate Ligament (PCL)
The posterior cruciate ligament (PCL) is the other main stabilising ligament inside the knee. Its main function is to prevent the tibia (shin bone) from sliding backwards and rotating on the femur (thigh bone). Tears/ruptures of the ligament result in knee instability. PCL tear is less common than an ACL tear.
Causes
PCL tears are typically caused by trauma or a fall on the knee. A direct posterior/backward force on the tibia commonly seen in collision sports or the knee hitting the dashboard in a motor vehicle accident will cause a PCL tear.
Symptoms
PCL tears cause immediate pain and often swelling. You may feel something “pop” inside the knee. An initial inability to bear weight on the leg may subside and walk may be possible after several minutes. The knee may feel loose or that it is going to “give out” and immediate return to sport is impossible. Over time, swelling will increase, and motion may be lost. Unlike ACL tears, some patients, even athletes, can return to sport with partial PCL tears (albeit in a knee brace) and never require surgery.
Diagnosis
Your surgeon will perform a thorough history and physical exam with X-rays. On exam, swelling and loss of motion and strength are present. Your surgeon will perform manoeuvres to check the stability of all the knee ligaments and the meniscus. An MRI is helpful to confirm the diagnosis, showing the PCL tear. The type of tear (partial, complete, avulsion from either the tibia or femur) can be defined, which may assist in treatment planning. The MRI may also show bruising bone secondary to the injury.
Treatment
Non-operative
PCL tears do not heal. However, some patients may return to normal activity depending on the type and severity of the tear. Non-operative treatment consisting of anti-inflammatory medication, physical therapy, cryotherapy and activity modification may be prescribed to decrease the swelling, regain motion and strength. A brace may be prescribed to return to sports activities. If symptoms persist (pain, instability), reconstruction surgery may be recommended by your surgeon.
Operative
Operative management of PCL tears depends on the type of tear. PCL repair may be indicated in patients where the PCL is torn off the femur wall (thigh bone) or tibia (shin bone. PCL repair is accomplished through a minimally-invasive arthroscopic procedure and sewed back into place and fixed with screws or buttons. The repair may also be supplemented with high-strength suture. If formal reconstruction is required, a new PCL graft will be fixed in place of the original ligament. A technique for graft placement and graft choice is a shared decision between you and your surgeon. Most techniques are performed through a minimally-invasive arthroscopic procedure. The graft can be taken from around your knee or from a donor. Postoperative rehabilitation, return to daily activities and return to sport depends on the technique and graft chosen, and is at your surgeon’s discretion.