What has gone wrong?
You have torn your anterior cruciate ligament, probably due to a fall or a sports injury. This will make your knee give way or feel as if it will give way; this is called an unstable knee. It may stop you doing your normal work and sports. The ligament will not heal if it is torn. It cannot be repaired but may be reconstructed.
The aim of the operation is to reconstruct the torn ligament with one or more tendons taken from your knee. There is a choice as to which tendons can be used to reconstruct the ligament. These are a graft of patellar tendon with bone at either end, or one or two of the hamstring tendons. Both work well, but they do have their own problems.
Patellar tendon - Taking the patellar tendon graft may leave you with tenderness on kneeling after your operation. If your work, sport or religion involves kneeling, or you have had pain in the front of your knee, a hamstring graft may be better.
Hamstring tendon - The hamstring tendon graft may weaken the remaining hamstring muscles. You may have numbness on the inner side of the leg. The graft may pull out of place. The graft may not be as strong as a patellar tendon graft.
Artificial tendons - These nearly always break if used on their own but they may be useful in reinforcing a tendon graft.
The operation should make your knee feel stable again. Your knee will not feel as if it is going to give way. Reconstructing your ligament may also reduce the chance of arthritis in your knee when you are older.
Are there any alternatives?
If your knee does not feel too unstable, and you do a lot of therapy to build up the muscles around your knee, it may become stable enough for your needs. You may not then need to have an operation.
Some surgeons use an arthroscope to see where the new ligament needs to go. The majority make a slightly larger incision and do not use an arthroscope for this part of the procedure. There is no difference in the result between open and arthroscopic surgery.
What if you do nothing?
Without an operation, your ligament will not repair itself. Your knee may become more unstable with time and suffer further damage, perhaps leading to arthritis.
Who should have it done?
You should have the ACL reconstruction if your ligament is completely torn and:
- you participate in vigorous sports, such as football or skiing or
- your knee feels unstable during day-to-day activities, even after undergoing a course of physiotherapy.
Who should not have it done?
You should not undergo ACL reconstruction if either of the following apply to you:
- you already have significant arthritis in your knee
- you are not prepared to go through the rehabilitation that follows the operation.
The above information is © Dumas Ltd 2006.