ACL Preservation

An innovative treatment Mr Sinha has introduced at Imperial College is ACL preservation surgery.

Candidates for this procedure are those whose ACL has detached from the femoral insertion and must be diagnosed acutely- within 10 days.

In such cases where the MRI supports an acute femoral avulsion ACL preservation surgery can be planned and performed (within three weeks of injury).

The surgical procedure is performed arthroscopically (keyhole/ minimally invasive incisions).

The procedure involves surgically repairing the natural ACL back onto its insertion on the femoral condyle.

ACL preservation surgery does not require the use of your hamstrings or patella tendon (versus ACL reconstruction where the graft is reconstructed using the patient's own removed hamstring tendon or quadriceps tendon).

This is preferential for preservation of the natural ACL's joint positioning receptors and maintaining your own hamstring/ quadriceps anatomy and strength.

Certain sports are very dependent on the hamstring muscles (eg rock climbing) and some patient's prefer to not have their hamstring tendon's harvested for use in standard ACL reconstruction.

The procedure is normally performed as a day case. A brace is worn for the first three weeks and partial weight bearing with crutches is also recommended (to help reduce post operative swelling). Full range of movement is encouraged from day one. Full weight bearing is allowed from week three and a daily exercise bike regime on low resistance recommended. The use of a cross trainer can be introduced once you are able to complete 10 minutes on the exercise bike. Straight line running can begin at 6 weeks post operatively. For the first twelve weeks closed chain strengthening exercises of the quadriceps and hamstrings are performed. Open chain exercises are avoided for the first 12 weeks (as such exercises can stretch the repair and lead to early failure). Pool walking is encouraged after your surgical wounds have healed (ie after first surgical follow up consult). Swimming in the first twelve weeks MUST avoid leg kicks (again to avoid stretching the repaired ligament) and so must be performed gripping a float between the knees.

MRI scan of ACL femoral avulsion suitable for acute repair

Intra-Operative picture of avulsed ACL

Intra-Operative picture of repaired ACL

Post operative AP and lateral radiographs of ACL repair