Adult and Paediatric ACL injuries

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ACL injuries are common amongst active people. Sporting injuries are a common cause. Certain groups are at higher risk, such as females, adolescents, contact athletes and jumping sports. To help PREVENT and ACL injury Dr Drynan recommends using the FIFA 11+ warm up protocol. Silvers-Granelli et al published a paper 2017 stating the risk of ACL tear in male soccer players was 16% for those whom followed the FIFA 11+ warm up compared to 84% who did not.

ACL research is expanding at a phenomenal rate, investigating different strategies and treatment options. It can be confusing and discussing your options with Dr Drynan would be advisable.

As the ACL is required for stability of the knee in certain movements, often it would be recommended to perform a reconstruction in the young active population. There is mixed scientific evidence for the very young and the less active individuals. 

Tailoring a management plan to your needs will be discussed between you and Dr Drynan.

Regardless of the specific strategy in managing your condition, physiotherapy and regular reviews will be utilised.

Time of injury:

rest, ice, compression, elevation

Timely assessment and investigation with XR and or MRI of the knee to diagnose and assess for concomitant injuries. This information along with your activity goals and medical history, including growth remaining for paediatric ACL reconstruction will be used to help with decision making.

Physiotherapy use in the pre operative phase is advised to improve pain, range of motion, knee swelling and muscle activation around the knee. Through physiotherapy in PREHabilitation, a full pre operative range of motion may be achieved. and aid in post operative rehabilitation. Certain populations, low demand, arthritic, stable knees. may not need a reconstruction. Active patients who undergo an ACL reconstruction would benefit from post operative rehabilitation. These exercises are guided by the physiotherapist and follow protocols. Talk to Dr Drynan regarding specific changes or sporting goals in your rehabilitation.

The recovery process for a standard ACL reconstruction is approximately 1 year. Certain graft choices may decrease this time, but full recovery depends on graft integrity, graft function and muscle function of the whole body. 

To have sports clearance, often a physiotherapist will perform specific exercises and tasks to clear for sporting duties, such as single leg jumps and strength assessment.

For elite athletes return to graded sports training may be accelerated slightly with an MRI assessment of graft and clinical examination.

As with all surgery, complications exist. Common complications such as stiffness, numbness over a small area on front of the knee, scaring, pain and swelling. Rarer complications such as infection, fracture to the tibia or patella, graft rupture or revision surgery. Dr Drynan performs stump preservation ACL reconstruction, to improve healing and vascularity and restore anatomy, This does however lead to a approximately 4-5% of secondary knee arthroscopy.

Will I need crutches?

• Yes. Most people find it more comfortable in the first 2-4 weeks using crutches for walking and quickly remove them to walk under their own power.

Will I need to do rehab for ever?

• Not rehab, but evidence would suggest when returning to sport, significant ACL specific warm up and ACL injury prevention exercises are beneficial in preventing further injuries. See FIFA 11+ link.

Will I be in hospital overnight?

• Usually not. For younger patients, or done at the end of the day, some may find it more comfortable to stay overnight, but the majority of ACL reconstructions are done as a long stay day case.