ACL injury and reconstruction

What is it?

The Anterior Cruciate Ligament (ACL) is a tough band of tissue that helps to keep  the knee stable and its main role is to prevent excessive forward movement of the tibia (shin bone) on the femur (thigh bone). It attaches from the tibia up and backwards to bottom of the femur. The ACL can get injured by excessive twisting movements at the knee, hyperextension (where the knee straightens too far) or by excessive knee flexion (where the knee bends too far). This is usually through a non-contact mechanism, however contact injuries account for about 30% of all ACL injuries and more injuries happen in females than males. 

How is it fixed? 

Depending on the extent of the injury, you may or not be offered surgery to reconstruct the damage ACL. Your Doctor and physiotherapist will discuss the best option for you, with you. Factors that will affect this decision depend on age, the amount of damage to your ACL and how active you are. 

Should the decision be made to have the ACL reconstructed, the surgeon will graft a “new” ACL from either your hamstring or gracilis muscle tendon, or your patella tendon at the front of your knee. There is little difference in your rehabilitation outcome with each graft and your surgeon will decide which option is best based on a variety of factors. The surgeon will remove the damaged parts of the original ACL and drill holes in your tibia and femur. Within these holes, the new graft will be placed and secured and will become your new ‘ACL’. 

Rehabilitation 

The typical time for rehabilitation is between 9-12 months. This varies depending on the level of activity you wish to return to and how well you do with rehabilitation. There are different phases of rehabilitation, focused on achieving different outcomes to allow you move onto the next phase. Some people will progress faster/slower than what is described below. A brief description of each phase is listed below. 

Phase I (Pre-operative)

  • Increase leg strength
  • Maintain normal function

Phase II (Immediately Post-operative; Week 1-2)

  • Restore normal knee movement and flexibility (range of movement)
  • Restore normal walking
  • Wean from crutches
  • Reduction of swelling
  • Scar management

Phase IIIa (Strengthening; Week 2-6)

  • Leg muscle strengthening (Closed kinetic chain exercises)
  • Balance improvement
  • Swelling maintenance

Phase IIIb (Strengthening; Week 6-12)

  • Leg Muscle Strengthening (Open kinetic chain exercises)
  • Start cycling and running at low speeds

Phase IV (Preparation for return to sport; Month 3-6) 

  • Non-contact, sport specific drills
  • Jumping, hopping & landing practice

Phase V (Return to sport; Month 6-9)

  • Gradual re-integration back into practice
  • Slowly start introducing contact

Phase VI (Return to competition; Month 9+)

  • Cleared to play competitive games

References

Beardshaw, A., Penhaul, L., Kennedy, N., Clayton, L. & Wheeldon, N. (2012). ACL Reconstruction physiotherapy advice for patients. URL: https://www.ouh.nhs.uk/patient-guide/leaflets/files/121210acl.pdf

Boden, B. P., Sheehan, F. T., Torg, J. S. & Hewett, T. E. (2010). Non-contact ACL injuries. Mechanisms and Risk Factors. Journal of American Academy of Orthopaedic Surgery, 18 (9): 520-7

Duthon, V. B., Barea, C., Abrassart, S., Fasel, J. H., Fritschy, D. & Menetrey, J. (2006). Anatomy of the Anterior Cruciate Ligament. Knee Surgery in Sports Traumatology and Arthroscopy, 14: 204-13

Eitzen, I., Holm, I. & Risberg, M. I. (2009). Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. British Journal of Sports Medicine; 43: 371-6

Relph, N., Herrington, L. & Tyson, S. (2014). The effects of ACL injury on knee proprioception: A Systematic Review. Physiotherapy, 100: 187-95

Samuelsen, B. T., Webster, K. E., Johnson, N. R., Hewett, T. E. & Krych, A. J. (2017). Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? A Meta-analysis of 47,613 Patients. Clinical Orthopaedic Related Research, 475 (10): 2459-68.

COVID-19 NOTICE

 

5 STAR CLINIC LTD has put in place several measures to assess and manage the risk of Covid-19 transmission.
Be aware that is not possible to completely eliminate this risk and that a face to face consultation will increase
the likelihood of you contracting COVID-19.

Full information here: 5 STAR CLINIC LTD COVID-19 POLICY

 

BEFORE BOOKING A FACE TO FACE APPOINTMENT:

We are following the CSP chart “Virtual first”, therefore you will be required to have
a Video Consultation at first(15min FREE), where a Triage questionnaire will be also administered.

At the end of the Video Consultation, we will decide if is deemed necessary
a FACE to FACE appointment or if we need to proceed with a virtual consultation.

CLICK: REMOTE OR FACE TO FACE CONSULTATIONS GUIDANCE

 

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    Please DO NOT ATTEND:

    1. If you have you been in close contact (<1m for at least 15 minutes without any protection) with a confirmed case of COVD-19
    2. If are you in the list of clinically extremely vulnerable people, click here: VULNERABLE GROUP
    3. If either you or one of your household has been ill in the last two weeks
    4. If you are suffering from any of the below:
      • Shortness of breath.
      • New persistent cough.
      • Fever over 38 degrees C.
      • Change or loss of taste/smell.

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      SUMMARY OF MEASURE IN PLACE TO REDUCED THE RISK OF COVID-19 TRANSMISSION:

    • We follow hand and hygiene practices throughout the meeting.
    • We provide hand sanitizing facilities and a surgical mask (Type IIR)
    • We minimise contact time closer than 2 metres and for less than 15 minutes
    • We keep at least 15min gap between patient for environment decontamination
    • We provide adequate air changes (average of 15min/hour with 4 to 6 air changes)
    • We provide cleaning and decontamination of equipment, surface and areas
      between each patient
    • Throughout the clinic are placed relevant posters to raise awareness and help in
      managing the risk of transmission
    • We follow safe removal and disposal of PPE in accordance with infection prevention
      and control during Covid-19 document
    • In the waiting area, a maximum of 2 people at a time at a distance>2m will be allowed.
      The patients know where to sit, as in the sitting area 2 chairs are provided only.
    • We follow Respiratory and cough hygiene – ‘Catch it, bin it, kill it’. Disposable, single-use tissues
      should be used to cover the nose and mouth when sneezing, coughing or wiping and blowing the nose,
      used tissues should be disposed of promptly in the nearest waste bin tissues. To be followed from hand hygiene.
    • We are only using disposable or washable material (such as couch covers, paper tissue, couch/pillow etc.)
      The therapist will be wearing PPE in line with government guidelines (disposable gloves, plastic apron,
      surgical mask (Type IIR), eye protection or Visor will be used if at risk of droplets)

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      WHAT DO WE REQUIRE FROM YOU?

    • To arrive on time for your appointment.
    • To do not arrive before or late to avoid crowding in the waiting area.
    • On arrival will be taken a contactless temperature reading.
    • To wear a surgical type mask during the waiting and the treatment*.
      a mask will need to be purchased at the clinic if you do not bring one.
    • To wash or clean the hands with hand sanitizer on the arrival and before.
      leaving and whenever may be needed to reduce the risk of contamination.
    • Please try not to use the toilet if possible and DO NOT USE self-service area.
    • On each face to face consultation, you will be required to fill and sign a Triage questionnaire.
    • Maintain 2 metres separation where possible, for instance, during the subjective examination.
    • To avoid cash payments preferably using contactless payments as much as possible), or online transfers.
    • To come alone unless strictly necessary to be accompanied. After entered the building, the companion will be allowed
      to enter only if strictly necessary (see below chaperone/translator).On the other hand, will be asked to leave and wait in the car.
    • In the case of chaperone/ translator is required will be asked to stay 2m apart of all the time from everyone, also they will need
      to complete a pre-screening questionnaire.
    • Follow Respiratory and cough hygiene – ‘Catch it, bin it, kill it’. Disposable, single-use tissues should be used to cover the nose
      and mouth when sneezing, coughing or wiping and blowing the nose, used tissues should be disposed of promptly in the nearest
      waste bin tissues. To be followed from hand hygiene.
    • Confirm contact details for the patient and each person accompanying the patient and inform them that these details may be used
      for contact tracing if required.
    • If possible, an electronic signature will be used on all of the document, if not a signature with a clean pen, after the hands have
      been sanitized

 

* Patient use of face masks

In clinical areas, common waiting areas or during face to face treatments patients is required to wear a surgical face mask.
The aim of this is to minimise the dispersal of respiratory secretions and reduce environmental contamination.
A surgical face mask should not be worn by patients if there is potential for their clinical care to be compromised (such as when receiving oxygen therapy).

 

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For more detailed information Covid-19 policy click HERE.