For those unlucky enough to damage their knee, whether through trauma or sporting injury, the most likely injury is to the ligament and, amongst knee ligament injuries, the anterior cruciate ligament is the most vulnerable, accounting for 49% of injuries.
A surgical procedure to repair a tear to the anterior cruciate ligament, commonly known as ACL reconstruction, is a possibility. But, is surgery always necessary? Swedish researchers led by Dr Richard Frobell, published a report in 2010 which stated that 60% of ACL reconstructions could be ‘avoided in favour of rehabilitation’. They then followed that report up with a follow-up study in 2013, published in the British Medical Journal, that confirmed their findings.
The researchers claimed that there was no increased risk of developing osteoarthritis or requiring meniscal surgery later on if the patient underwent physiotherapy alone. The level of function, pain and activity were also no different. Half of the group that hadn’t undergone surgery initially went onto have a procedure to address instability, but the delay in surgery also had no discernible difference in outcome to those that underwent surgery immediately.
Why is an ACL reconstruction necessary?
The knee is a hinged joint and the anterior cruciate ligament runs through the joint, connecting the femur to the tibia and preventing the tibia from sliding in front of the femur. It is also required for rotational stability of the knee and, as a result, is often damaged when a player lands or pivots awkwardly.
If you’ve torn our ACL, whether partially or completely, then you’ll usually be aware of it immediately. Patients often report a ‘popping’ sound and experience pain and swelling straightaway. The knee may also feel unstable and give way.
It is important to seek medical advice if you suspect you’ve torn your ACL; a partially torn ACL can ‘recover’ if you follow a prescribed rehabilitation programme. However, a completely torn ACL may leave sufferers experiencing instability, with the knee giving way even while performing normal activities, which prevents a return to sport.
Why won’t the ACL heal itself?
The body is an amazing machine, capable of self-healing much of the damage we do to it. However, the position of the anterior cruciate ligament means that the body cannot heal even a partial tear. One of the other main ligaments of the knee, the medial collateral ligament, runs outside the knee joint and, when torn, a blood clot forms that provides the scaffold for new collagen tissue to form and fill the tear. However, the ACL runs through the knee joint which is continually flushed with lubricating synovial fluid. This fluid prevents formation of a blood clot.
During your knee injury consultation with Mr Jonathan Webb, the extent of the injury to your ACL will be evaluated with a physical examination and MRI scans. Other factors to take into account is the degree of stability in the knee joint and your personal circumstances: Do you perform light manual work? Would you like to return to a demanding sport that requires pivoting, cutting and landing? Are you very active or lead a relatively sedentary life?
Once the picture has been built up, Mr Webb can offer expert, impartial advice on whether ACL reconstruction surgery is the right option for you. To arrange a consultation at either his London or Bristol knee clinics, call 08450 60 44 99.