Cruciate Ligament Injury

I’m seeing an increasing number of patients with knee ligament injuries. This is because people are keeping fit and active longer and more people are still actively taking part in contact and hazardous sports such as skiing as they get older. The Medial Collateral Ligament (MCL) is most commonly injured but usually responds well to non-operative treatment and surgery is often not required.

The anterior cruciate ligament is a complex and very important structure to the stability and function of the knee joint not only in sports but also in the activities we carry out on a daily basis. It is the second most commonly injured knee ligament, often occurring with a meniscal injury.

Tearing this ligament often leads to instability of the knee and it stops an individual taking part in sport or simple pivoting movements during normal activity. Long term instability, with giving way of the knee, is associated with premature wear (osteoarthritic) change in the joint.

The anterior cruciate ligament passes in the centre of the knee connecting the femur (thigh) and tibia (shin) bones together. The knee joint is capable of complex movements during which the femur and tibia are held together by the anterior cruciate ligament which is the primary (most important) restraint to the knee. Other ligaments around the knee aid in stability, but they are of less or secondary importance to knee joint stability.

Therefore, if you rupture the anterior cruciate ligament, the femur is able to move in an abnormal and unrestrained way on the top of the tibia causing instability or “giving way” of the joint. This may cause further cartilage injury and, in the long term, is associated with degenerative change or osteoarthritis in the knee.

Reconstruction of the ACL is aimed at restoring function and stability to the joint and in the long term preventing any early wear and tear changes or subsequent cartilage damage. There have been significant advances in the technique allowing me to reconstruct this ligament with some great results for my patients.

Currently, there are two main types of reconstruction available. With both procedures, I use the patient’s own ‘ligament like’ (tendon) tissue as grafts. These use either two of the Hamstring tendons or the central part of the Patellar tendon. The decision which to use is based upon the build of the patient, their sporting activity and condition of the knee.

Both procedures are performed predominantly arthroscopically, except for the tendon graft harvest which must be performed through a small incision over the front part of the knee. The position of the graft is all important to this procedure and considerable expertise and care is required to correctly orientate the graft and re-establish the stability of the knee. New methods of fixation allow immediate mobilisation and full weight bearing straight after the operation without the use of a knee brace.