THE ACL

How many times have your heard these three letters while watching your morning hi-lights? ACL stands for anterior cruciate ligament. Maybe we should start briefly with what a ligament is! Ligaments are bands or rope-like strands of fibrous, connective tissue that connect one bone to another. They are important because they help to keep the joints in our body together, protecting them from pulling or twisting apart. The ACL is the main internal ligament in the knee joint. It prevents the shin bone (tibia) from shifting too far forwards relative to the thigh bone (femur), and gives the knee the stability it needs for athletes to make sudden, sharp cuts or pivots. It is commonly injured in sports like soccer and football, where athletes are on turf, and wear cleats that help with grip. With all of the sudden stopping and starting, and sharp turns with footwear that grips the playing surface really well, the knee becomes vulnerable to a “plant and twist” injury. Basically the cleats grip the turf really well, stopping the foot from moving, but the momentum of the body moving causes the knee joint to twist or buckle. With enough force, this can completely tear the ACL.

Most often with athletes, the best way to treat a torn ACL is with reconstructive surgery. Unfortunately surgeons can’t simply sew the ACL back together, they have to build a new one, hence the term reconstructive. Most often they will use a piece of one of the injured athletes hamstring tendons. So, they make a small incision, clip off a piece of the hamstring tendon, then bring this harvested piece of tendon over to a small table in the operating room. Then they fold it over on itself and use sutures to “build” the ACL, making it a similar length and thickness to the original ligament. Then the surgeon will drill holes into the shin bone (tibia) and thigh bone (femur) and anchor each end of the newly constructed ACL into these holes. The new ACL is placed on an angle that is as close as possible to the original ligament. And the cool part about this whole procedure, is that is done completely with a technique called arthroscopy.

Arthroscopy is a type of surgery that is minimally invasive, it uses tiny instruments with lights, cameras, and tools on the ends of long, cord-like instruments. This allows the surgeon to make only the tiniest incisions necessary to access the area they would like to operate on.

The images/video feed from the camera goes on a monitor in the operating room that the surgeon watches as he or she performs the surgery. So in the case of ACL reconstruction, it means they don’t have to open the knee joint right up. This is important as it allows for a much quicker recovery, and much less chance of infection after surgery.

Post surgery is where someone like myself (a Physiotherapist) would take over, and the rehabilitation process would begin. It is a gradual process at first as the new ACL needs a chance for bone growth to occur at each end of the ligament. Typically, depending on the individual, and the sport they play, the rehab process can take between 6 and 12 months, with the later stages focussing on exercises that really mimic the demands of the individual’s chosen sport.
What once was a potentially career threatening injury, ACL tears are now simply season-ending injuries. Still devastating in their own way, but not necessarily life-altering the way they once were. The ACL reconstruction procedure has become one of the most common orthopaedic (bone/muscle/joint) surgeries in existence, especially for the younger, athletic population.