ACL Repair – and back on the slopes!

This video was sent to us by the patient to show how well he was doing at 4 months after ACL repair. Here below he tells his own story -

I'm an active 32-year-old who spends a lot of time climbing up mountains and going down them in various different ways. Both of these activities require a strong pair of knees. So I was devastated to hear in May 2015 that I had ruptured my ACL following a skiing accident.

I was initially told that I could forget skiing/snowboarding for at least a year, maybe even longer. They said the rehab would be long, hard and painful - full commitment to the rehab programme would be required to get myself even near the shape I was in before.

I was explained about how a full ACL reconstruction surgery - the standard procedure worldwide to fix a ruptured ACL - would work: the surgeon would remove the torn ACL and replace it with some tendons from my hamstring. I would have to go very easy on the knee during the rehab to ensure the tendons would grow into place, since they would be very fragile for the 9-12 months after the graft is performed.

I was put in touch with Adrian Wilson by chance. I sent my MRI scans through to him and was surprised when he said he could actually repair the ruptured ACL instead of creating a new one, saying that I could be back to normal activities within 3-4 months after the operation. Adrian assured my that the tissue left over was in good enough shape to be repaired.

He explained to me that he was performing a new type of surgery to fix ACLs - or at least repurposing an abandoned technique from the old days with modern tools and tricks.​

​What he would essentially do was stitch up the torn ACL, create an internal brace made out of kevlar and use some clever drilling to support the repaired ligament until it was healed.

I signed up and was scheduled for surgery in early July. The first few days after the surgery were obviously quite difficult while the knee recovered from the trauma of the surgery. After three days of resting I began the exercises to get the range of movement back in my knee.​

I got rid of the crutches within about five days, was driving within two weeks and was in the gym cycling and doing light jogging within three weeks. The first month was crucial: keep to the exercises and icing and progress will be fast.​

By month two I was performing a relatively normal workout in the gym, only that I was not really using weights. In month three I restarted Crossfit. I was surprised to see that I could actually support and lift heavy weights and the bits of twisting I did hadn't given me any problems.​

My first real return to old activities was 10 weeks after the procedure. I did a 20km hike, climbing up 1300m and back over about 6-7 hours. My knee was actually better than before. I continued hiking throughout the Autumn, eagerly waiting to get back on a snowboard.

Had snow arrived earlier in the winter, I would've returned to skiing earlier. But when I did finally get back on the snow in December, I was amazed at how normal it felt, considering what had happened. Psychologically, the knee felt weird the first day skiing, but after a while I had completely forgotten about it.

I was skinning up and down mountains in the backcountry on day one, buttering around the slopes on day two, hitting the kickers and jumps in the terrain park on day three, and on cloud nine by day four.

If it weren't for this surgery I wouldn't even have a season of skiing ahead of me. Now, I've even managed to get the season going ahead of when I normally would.

If the conditions are right for you to undergo the ACL repair, it really is a no-brainer. Go for it and don't look back."

Frazer
ACL repair
Adrian Wilson

ACL REPAIR IN A  KEEN SNOWBOARDER!


This young man - Frazer - actually came over from Kosovo for his surgery. He had heard about our repair techniques for ACL repair surgery and came over specifically for it. He is a very active chap and enjoys mountaineering and snowboarding, and really wanted to get back to his activities quickly. He sent me his scans. I felt that he was a suitable candidate for ACL repair, and he flew over and had the surgery. You can see from the video just how well he was doing at 4 months. He is now coming up for 9 months and still doing really well. He tells this really funny story below:

"Got progressively bigger and bigger with the jumps. At one point I landed a pretty big jump, absorbed all the heavy impact with the knees and felt and heard a massive popping sound. Turned out to be my snowboard trousers ripping open on the backside!"

ACL repair versus reconstruction

ACL repair is a procedure to enhance healing of the damaged ends of the anterior cruciate ligament, without cutting away the remnants or using a graft.

The concept is an old one, but the procedure went out of fashion as graft techniques for reconstruction initiated in the 1980s and matured through subsequent decades. However it is now appreciated that the remnant or stump of the original ACL is important in restoring the nerve supply that gives the knee 'proprioception' or position sense. 

By using 'internal bracing' with FibreTape, ​the repair can be braced until the repaired tissue is strong again.

ACL repair with internal bracing has shown itself to be very effective ​in my paediatric group who are ideal candidates for repair most of the time.

Surely with such a high revision rate of reconstruction, ACL Repair should be attempted first?

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