Ligament reconstruction (Keyhole)

Ligament injuries are common following twisting or pivoting injuries whilst doing sports. The most common injury is the anterior cruciate ligament or ACL.

The ACL is an important knee stabiliser and there is evidence that the stability from the ACL helps reduce the chance of injuries to other structures within the knee, such as the meniscus. Nevertheless, there is always the option to manage ACL ruptures with rehabilitation and without surgery.

We can’t repair the ACL reliably, so we use a tendon graft instead. There are several options, but we use the quadriceps graft as it’s a reliable thick size, has a low re reupture rate, and preserves the hamstrings which are important for sprinting power.

We use the Arthrex Graftlink construct, and occasional use extra techniques around the knee to increase stability, but this is rarely needed. We position the implants and graft under Xray guidance to ensure the tunnels are placed in the ideal position to get the best outcome.

After surgery we will supply a knee brace to help you rehabilitate, and you can start physio at a couple of weeks to get the knee moving and reduce swelling. Most of the pain and swelling will have reduced by 4-6 weeks, but it can take 3-4 months to fully settle. Most people are back to cycling at 6 weeks, in line running 10-12 weeks and cutting sports at 6-9 months. The longer time period for ligament reconstruction is because we wait for the body’s ‘sharpeys fibres’ to fix the graft to the bone, so the reconstruction is not reliant on the implants we use to hold the graft, but have incorporated into the bone more like a native ACL.