I perform a large number of anterior cruciate ligament reconstructing, I input data into the national ligament registry which demonstrates my patients to have high levels of function and return to activity post surgery.
I attempt to tailor the surgery I perform to the patient's injury, age, anatomy and sporting activity. With this surgery there are a number of options in terms of technique, and also what we use to replace the ligament. I am proficient at all the various techniques rather than just using one so can discuss all the options available with you.
In a very few cases it may be possible to directly repair the ligament rather than borrowing tissue from elsewhere to make a new ligament. This is only possible if the ligament has pulled off cleanly from the thigh bone side of the joint and not snapped in the middle, surgery also needs to be performed a few weeks after injury. Even then success is not guaranteed. However it does mean that no tissue is taken from elsewhere and if successful is the most natural result.
In patients who are regularly performing contact sports such as rugby I will often use the middle part of the knee-cap tendon. This graft uses bone from the knee cap and tibia to heel into tunnels that are drilled as part of the reconstruction.
In most patients I will use 1 or 2 hamstring tendons folded over to make a new ligament. This has the advantage of being slightly easier to recover from. We can also sometimes consider using the quadriceps tendon.
LET (Lateral Extraarticular Tenodesis)
Despite our best efforts some cruciate ligament reconstructions sustain a re-injury and the reconstructed ligament is re-injured. Many studies have shown this to affect around 10% of reconstructions. However there are some patients or situations where we recognise that the risk of re-injury is much higher than that. One way that has recently been shown to reduce that re-injury rate is to reinforce the reconstruction with a procedure on the outside of the knee where some tissue is re-routed to help control the rotation of the knee which is often the cause of injury. This procedure is known as a Lateral Extraarticular Tenodesis. I have been using this procedure to improve the results of surgery patients who I consider to be at higher risk.
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