Revision Anterior Cruciate Ligament (ACL) Reconstruction
A complex procedure to address issues from a previous ACL reconstruction and restore knee stability
The ACL is a key ligament in the knee joint, responsible for stabilising the knee during activities involving pivoting, jumping, or rapid changes in direction. Revision ACL reconstruction is recommended when the previously reconstructed ligament fails to provide sufficient stability, leading to pain or limited function.
Common Reasons for Revision ACL Reconstruction
- Recurrent instability or giving way of the knee following initial ACL surgery.
- New trauma or injury causing additional damage to the reconstructed ligament.
- Improper placement or failure of the initial graft or fixation devices.
- Progressive damage to surrounding structures, such as cartilage or menisci.
The primary goals of revision ACL reconstruction are to stabilise the knee, address underlying issues from the previous surgery, and restore function.
Preparation for Surgery
Comprehensive evaluation and pre-surgical planning are essential for successful revision ACL reconstruction. Dr Ben McGrath will conduct detailed assessments using imaging studies like X-rays, MRIs, or CT scans.
Key Steps in Preparation:
- Consultation: Dr McGrath will discuss the reasons for the revision, the surgical approach, potential risks, and expected outcomes.
- Pre-Surgical Instructions: Patients may need to fast and adjust medications, such as stopping blood thinners.
- Physical Conditioning: Prehabilitation exercises to strengthen the muscles around the knee may enhance recovery.
Lifestyle Adjustments: Weight management, smoking cessation, and addressing other health factors may optimise surgical outcomes.
What Happens During the Surgery?
Revision ACL reconstruction is a complex procedure typically performed under general anaesthesia. The surgical approach may vary depending on the condition of the knee and the previously used graft.
Surgical Steps:
- Incisions: Small incisions are made to access the knee joint.
- Evaluation and Removal: The surgeon assesses the condition of the knee, removes failed grafts or hardware, and addresses any associated damage.
- Graft Selection: A new graft is harvested, often from the patient’s hamstring, patellar tendon, or a donor source.
- Tunnel Creation: New tunnels are drilled in the femur and tibia to accommodate the new graft.
- Graft Placement: The graft is secured in place using screws or other fixation devices.
- Closure: The incisions are closed, and the knee is bandaged for protection.
The procedure may take longer than primary ACL reconstruction, typically 2 to 3 hours.
Understanding the Risks
Revision ACL reconstruction is a safe and effective procedure, but like any surgery, it carries certain risks:
- Infection: At the incision sites or within the joint.
- Graft Failure: Rarely, the new graft may not function as expected.
- Stiffness and Swelling: Temporary inflammation or reduced range of motion.
- Blood Clots: Rare but possible in the lower limbs.
- Nerve or Vessel Injury: Extremely rare but a potential risk during surgery.
Dr McGrath employs advanced surgical techniques and follows stringent safety protocols to minimise these risks.
What to Expect After Surgery
Immediate Post-Operative Care:
- Pain Management: Discomfort and swelling are normal and can be managed with prescribed medications and icing.
- Assistive Devices: Crutches and a brace may be required to support the joint during initial recovery.
- Hospital Stay: Patients may stay overnight for observation, depending on the complexity of the surgery.
- Discharge Instructions: Detailed guidance on wound care, activity restrictions, and follow-up appointments will be provided.
Rehabilitation and Recovery
Recovery from revision ACL reconstruction involves a structured rehabilitation plan, tailored to the patient’s specific needs:
Phase 1: Early Recovery (Weeks 0–6)
- Focus: Protect the graft, reduce swelling, and restore range of motion (ROM).
- Activities: Partial weight-bearing with crutches, gentle ROM exercises, and cryotherapy.
Phase 2: Strength and Mobility (Weeks 6–12)
- Focus: Regain strength and mobility in the knee.
- Activities: Physiotherapy for strengthening, light cycling, and balance exercises.
Phase 3: Advanced Recovery (Months 3–6)
- Focus: Restore full function and prepare for sports or daily activities.
- Activities: Functional drills, resistance training, and agility exercises.
Phase 4: Return to Sport (Months 6–12)
- Focus: Safely return to high-impact activities.
- Activities: Sport-specific training and progressive running programs.
Long-Term Outcomes
Revision ACL reconstruction may help stabilise the knee, alleviate pain, and improve overall function. Long-term success depends on:
- Adherence to rehabilitation protocols.
- Regular follow-up appointments to monitor progress.
- Maintaining a healthy lifestyle to support joint health.
Most patients achieve significant improvements in mobility and stability, enabling them to return to their desired level of activity.