Anterior cruciate ligament tear
ACL tears commonly occur when changing direction quickly whilst playing sport e.g. football, rugby, netball, basketball etc.
Signs of an ACL tear
⦁ Severe pain at the time of injury
⦁ Knee swelling shortly after the injury
⦁ Unable to continue playing
⦁ Lack of stability in the knee—it ‘gives way’ particularly when changing direction
Non-surgical treatment:
It is recommended that patients have an initial period of physiotherapy (‘pre-hab’), to regain range of motion and optimize muscular control/balance before surgery. Once this is achieved (it may take a few weeks), surgery is recommended. Surgery minimizes the risk of further damage to the meniscus in the knee.
Anterior cruciate ligament reconstruction
Anaesthetic: general or spinal anaesthetic
Duration in hospital: overnight
During Surgery
Dr McGonagle will use a graft (hamstring tendons or bone-patella tendon-bone) and pass it through your shin bone (tibia) and thigh bone (femur).
Surgery on other parts of the knee, e.g. meniscus or other ligaments may be performed at the same time depending on the nature of the injury.
After Surgery
This varies depending on whether additional surgery to meniscus or other ligaments was necessary.
The whole rehab process takes about 1 year before patients are back at full sporting activities.
Practice nurse wound check at 2 weeks.
Review with Dr McGonagle at 6 weeks.
Ankle ligament injures
Ligaments on the outer (lateral) aspect of the ankle are commonly injured when ‘rolling’ (inverting) the ankle. This may occur on the sports field or missing a step.
It is associated with immediate pain, swelling, difficulty weight bearing and instability.
Non-surgical treatment:
Minor cases may need no formal treatment.
More severe cases should have a boot or brace that they can walk in for a few weeks, followed by a period of rehabilitation with balance and strengthening exercises.
If patients have ongoing instability and a sensation of the ankle giving way, then surgical stabilization is recommended.
Lateral ankle ligament stabilization
Anaesthetic: general or spinal anaesthetic
Duration in hospital: 0.5 days or overnight
During Surgery
You will have an incision on the outer (lateral) aspect of your ankle. Dr McGonagle will fix the ligaments back to the outer ankle bone (fibula) using suture anchors.
He will augment the repair with a piece of adjacent connective tissue (extensor retinaculum).
After Surgery
You will be in plaster after surgery and be non-weight bearing with crutches for 6 weeks after surgery.
Wound check at 2 weeks and plaster change with practice nurse – Dr McGonagle
You will be on aspirin for 6 weeks to minimize the risk of blood clots (deep vein thrombosis) and vitamin C to minimize the risk of complex regional pain syndrome (CRPS).
After 6 weeks you can weight bear in a boot for several weeks, then mobilise out of the boot.
You will see a therapist to work on balance and strengthening exercises.
Expect a full return to sport around 6 months post-surgery.