Thursday, March 19, 2009

Current Trends In Anterior Cruciate Ligament (ACL) Reconstruction Management

"A torn anterior cruciate ligament (ACL) is the beginning of the end" (Allan, 1974).

Fret not. Sports medicine and physiotherapy have come a long way since then.

The Physio Solutions Team will discuss some of the questions, controversies and evidence our patients, readers and friends may have with regards to having an ACL reconstruction.

In short, the ACL prevents anterior tibial translation, meaning if your foot and lower leg (shin bone or tibia) is fixed on the ground, it prevents the shin bone or tibia from moving forward excessively with respect to the thigh bone (or femur). It also limits excessive rotational movements in your knee.

First question will inevitably be "If I tear my ACL, do I need an ACL reconstruction?"

We will often ask our patients if their activities of daily living (ADL) are affected. If you cannot climb stairs, squat, run after the bus or have persistent giving way of your knee joint after injury then your ADL is definitely affected. Some people may be able to get away without a reconstruction if none of the discussed symptoms occur or structurally their knee joint may be sound.

We have seen some patients who do not do the operation and fare well. But they are few in numbers. Of course patient lifestyle factors such as present and future activity also play a part in decision making. In most cases, however, non operative management of the torn ACL usually leads to functionally unacceptable outcomes. Moreover, with many of our patient's increasing emphasis on sports, the majority of them will need a reconstruction especially those involved in sports that require changing directions, pivoting or jumping.

What choice of graft you choose in your reconstruction will and always be a subject of debate. Majority of operations done use either the bone-patella tendon bone (BPTB) or semitendinosus-gracilis (hamstrings) graft. Both have their pros and cons. We will discuss this in our next post. Stay tuned.

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