A knee injury is very common in both amateur and professional sports and the treatment of sports injuries has undergone something of a revolution in recent years. Surgeons have gone from reconstructing ACL injuries and excising damaged menisci to recognising and treating a much larger portfolio of injuries.
I bring a modern approach to sport and knee injury with experience gained from fellowships in Australia and Canada where I worked with several professional sports teams. In Canada, I worked with the surgeon for the Stampeders Canadian Football League team. The Stampeders were finalists in the Grey Cup (the Canadian version of the Superbowl) that year. Back in the UK, I have worked with a UK Strongest Man contender and a European taekwondo champion. I bring these experiences to bear with all new cases.
The job of the ACL is to detect and help control the rotation of the knee. The ACL detects and feeds back the knee position to your brain and muscles. Where rotation is excessive it acts as a checkrein to prevent excessive rotational movement. If the body fails to control this rotation and the ACL fails a checkrein then the ACL may be torn. The ACL is one of several restraints that prevent rotation of the knee. Any of those anatomic elements involved in preventing rotation can be injured in combination. This includes the menisci, the bone, the joint capsule, the collateral ligaments and even the posterior cruciate ligament in severe cases.
Physiotherapy alone can significantly improve knee stability, however, it does not restore the ligament. Most people wanting to get back to sports will need an ACL reconstruction but there are of course exceptions.
Although an isolated ACL injury does not usually require urgent surgery there may be other associated injuries that require urgent attention. It is always best to be seen by a surgeon as soon as possible.
There are several advantages to ACL reconstruction. An ACL reconstruction will provide more normal knee movement and some protection for your menisci (the shock-absorbers of the knee). Most importantly it should make the knee feel more normal. Most people will need an ACL reconstruction if they are planning on getting back to sports. Once you have injured your knee the risks of arthritis are there to stay. ACL reconstruction does not return the knee to normal but it offers several important advantages over non-operative care.
There are many options and most of them can be performed through keyhole surgery.
The “graft” is medical jargon for the tissue we will use to replace the damaged ACL. I use a variety of grafts depending on the exact circumstances. In theory, we can use your own tissue (autograft), another person’s tissue (allograft), animal tissue (xenograft) or artificial fibres. If using autograft (the most common) then you have several options including hamstrings, patella tendon, quadriceps tendon and many others. Each has its pros and cons.
I have been fortunate enough to receive training, working with amateur and professional athletes in Australia, Canada, India and the UK. We can discuss which technique works best for your knee injury in the clinic.
Yes! It is crucial to achieving the best recovery that you can.
Increasingly we are seeing that better outcomes are enjoyed by those who work at the knee after surgery. Physiotherapists, the myrecovery app, and your personal support network are all important resources that we can draw on.
The value of physiotherapy cannot be overemphasised. The goals of the physiotherapy programme are to:
No! It takes time to rehabilitate the muscles and coordination of the knee.
Usually, straight line running can be resumed after 3 months. Sports involving rotation or side-stepping movements (rugby, football, netball, skiing) take longer, usually 9 months. We have some cutting-edge techniques that accelerate rehabilitation.
Those who have an ACL knee injury are at risk of injury to that knee and of injury to the other knee. There are several reasons for this including bone shape, hypermobility and activity levels. There are some excellent injury avoidance programmes that we can access.
2 LCL Injuries
9 MCL Injuries
16 ACL Injuries
The ACL sensory function detects and prevents excessive rotation in the knee. ACL injuries occur when the knee twists excessively.
On average it takes 9 months to rehabilitate from an ACL injury and, after reconstruction, most elite athletes return to playing sports.
During the 2016–2017 Premier League football season, 27 footballers sustained serious knee injuries with the ACL being the most common injury.
ACL injuries are more common amongst female footballers than male footballers.
Having worked with professional teams and individual athletes in the UK, North America and Australia, the objective of successful surgery is to prepare the athlete to return to play. In most cases, this is the reality, whereby athletes have returned to the level of play they experienced before surgery.
“Since knee surgery, I have been able to fully rehab myself back up to the standard of lifting I was at before and more. I can squat pain-free now most recently lifting 280kg for 8 reps in competition.”
Ryan, UK Strongman Contender