Leigh’s New ACL!
Last week I was lucky enough to go and watch one of my patients having her ACL repaired.
About three months ago, Leigh was making her long awaited comeback to netball following an ankle injury. All was going well during the trials, her was ankle feeling sweet, until one awkward landing and her knee gave way from underneath her. As you can imagine this was a pretty devastating (and painful) moment. The swelling came up pretty quickly and her knee was immediately very unstable, giving way multiple times. She managed to see Leanna (another BIA physio) the following day who concerned she had ruptured her ACL so she referred her straight to a specialist. A couple of weeks later she was reviewed by Mr Aaron Cook, an orthopaedic specialist at Grace Hospital. He sent her for an MRI and unfortunately it was confirmed she had ruptured her ACL. Poor Leigh!!
So what is the ACL?
The anterior cruciate ligament (ACL) is a very important stabilising ligament of the knee. It stops the tibia (shin bone) sliding forward on the femur (thigh bone).
How does it rupture?
It normally ruptures when the foot is planted and there is a large twisting force to the knee. Often it occurs in sport with a tackle, direct contact or an awkward landing (as in Leigh’s case). It more commonly occurs in females than males.
Back to Leigh…..
After the acute pain had settled and the investigations completed, Leigh felt her knee was still unstable. This is when the decision to surgically repair it was made. Mr Cook reports his only reason for surgical repair is if the patient feels their knee is unstable. People can get by without surgery, especially if they work hard to strengthen the surrounding muscles. However for Leigh she needed it to be repaired.
So last Friday, Leigh went for her operation…..and I got to watch.
The first part of the surgery was preparing the replacement ACL. For this they used part of her hamstring tendon. Two strips of her hamstring tendon were taken out, folded in half and then stitched together and left in a bowl about 20cm from where I was standing! Next was cleaning out the old ACL with a shaving type tool and cleaning the area ready to put the new ligament in. Next holes were drilled in both the tibia and the femur. And finally inserting the new “ACL” putting a screw in to secure it in place. At this point Mr Cook tested the knee to see if it was stable and he was very pleased that it was. She was then stitched up and job done!
This time in theater was a great chance to learn about the surgery and anatomy but also to ask lots of questions about Leigh’s physio post-surgery. Leigh wasn’t given a brace and she is allowed to move her knee as much as she likes – however this will largely be dictated by pain levels. In the first few weeks, physio will mainly focus on getting the swelling down and increasing her range. As time goes on, there will be a large focus on strengthening exercises for her quadriceps, hamstring and gluts! Unfortunately, normal time frame for return to sport is about nine months so Leigh will have to wait until next season.
Although an ACL rupture is a pretty severe injury, Mr Cook was really pleased with his repair and confident that she would recover well. However the physio post-surgery is just as important in order to maximise her recovery and prevent any further damage!
Will keep you posted on how she goes!