Sports
Dr Matthew Broadhead has a subspecialty interest and training in treating sports injuries, with a particular focus on anterior cruciate ligament (ACL) reconstruction. Dr Broadhead was awarded a Master of Surgery (ChM) by the Royal College of Surgeons Edinburgh for research on ACL reconstruction techniques. He will ensure that all conservative options are considered prior to surgery using an evidence-based approach, taking into account a patient’s lifestyle, physical demands and sporting aspirations.
I have an ACL tear. Do I need surgery?
The decision to undergo surgery for an anterior cruciate ligament (ACL) tear will depend on a number of factors, including the severity of the tear, the patient’s age and overall health, and the type of activities they participate in.
In general, ACL surgery is typically recommended for individuals who have a complete or near-complete tear of the ligament and who experience instability in the knee joint. This is because a torn ACL can lead to ongoing knee instability and may increase the risk of further injuries, such as meniscal tears or cartilage damage.
For individuals who are active in high-impact sports or who have a high level of physical demands, surgery may be recommended to help restore stability to the knee joint and to allow them to return to their desired level of activity.
However, for individuals who are less active or who have a low level of physical demands, nonsurgical treatment options, such as physical therapy and bracing, may be sufficient to manage the symptoms of an ACL tear and allow them to maintain an acceptable level of function.
How is an ACL reconstruction performed?
ACL reconstruction surgery may be performed using a variety of techniques. In most cases, the surgery is performed using arthroscopic (key hole) techniques, which involve making several small incisions in the skin and inserting small instruments and a camera into the knee joint.
During the surgery, any damaged tissue will be removed and then the bone will be prepared to accept the new ligament. The new ligament may be made from a tissue graft, which may be taken from the patient’s own body (autograft), such as the patellar tendon or the hamstring tendon; or a donor graft (allograft).
Once the new ligament is in place, the surgeon will secure it to the bone using screws or other fixation devices. The incisions will then be closed, and the patient will be moved to a recovery room to begin the post-operative recovery process.
ACL reconstruction surgery is typically performed on an outpatient basis, meaning that the patient will be able to go home the same day as the surgery. However, some patients may need to stay in the hospital for one night.
What are the differences between the different grafts used in ACL reconstruction?
There are several different types of tissue grafts that may be used, including:
- Autografts: Autografts are tissue grafts that are taken from the patient’s own body. The most commonly used autografts for ACL reconstruction are the patellar tendon and the hamstring tendons.
- Allografts: Allografts are tissue grafts that are taken from a donor, rather than the patient’s own body. These grafts may be used if the patient’s own tissue is not suitable for use or if the patient has a high risk of graft failure.
Each type of tissue graft has its own advantages and disadvantages, and the best choice for a particular patient will depend on a number of factors, including the patient’s age, size, overall health, and the specific needs of the procedure. It is important to discuss the different types of tissue grafts with Dr Broadhead to determine the best option for your specific situation.
What are the risks of ACL reconstruction surgery?
While the surgery is generally successful in restoring stability to the knee and improving function, it does carry some risks, as with any surgery. Some of the potential risks of ACL reconstruction surgery include:
- Infection: There is a small risk of infection after any surgery. Symptoms of an infection may include fever, redness, swelling, and discharge from the incision.
- Blood clots: There is a risk of blood clots forming in the leg after surgery, which can be serious if they travel to the lungs or other organs.
- Nerve or blood vessel damage: There is a small risk of nerve or blood vessel damage during surgery.
- Graft rupture and revision surgery: In some cases, additional surgery may be needed to correct problems that occur after the initial surgery. It is possible for the graft to rupture and require revision surgery.
- Knee stiffness: Some people may experience stiffness in the knee after surgery, which may require physical therapy to improve mobility.
How soon can I return to sport after an ACL reconstruction?
The recovery time after an ACL reconstruction surgery will depend on a number of factors, including the specific type of surgery that was performed, the patient’s age, overall health, and the demands of the sport they plan to return to.
In general, it is typically recommended that patients avoid high-impact activities for at least the first few weeks following surgery to allow the incision to heal and the knee to begin to stabilize. After this initial period, patients can gradually resume physical activity as tolerated and as directed by Dr Broadhead and the physiotherapist.
Most patients will be able to return to low-impact activities, such as cycling or swimming, within a few weeks of surgery, but it may take several months (9-12 months) before they are able to return to higher-impact activities, such as running or playing contact sports.
It is important to follow the recommendations of Dr Broadhead and the physiotherapist, and to progress slowly and cautiously as you return to physical activity. It is also important to continue with your rehabilitation exercises to help strengthen the muscles around the knee and improve your range of motion.