ACL injury – the history gives the diagnosis

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Gareth is a physiology student who hopes to do medicine in the not too distant future, and is also an elite level rugby player who tore his right ACL. 

Gareth was working as a healthcare assistant and we met some time before his injury. He played elite rugby and had had a scholarship at school and a trial for Saracens.

A classic story

Before he met me he was going back into training and during the first training session had a classic non-contact injury to his right knee when he twisted, heard a 'Pop!' and he collapsed and felt it pivoting inwards. He had some transient discomfort and was hobbling for a few weeks and then got back to a good level of activity. He went through the local MSK service and was referred on to physio but sadly and not surprisingly he remained unstable whenever he tried to do any sort of twisting activities.

He felt strong enough to try things - in fact was dancing a few weeks before I saw him, when his knee gave way with a change of direction, leading to his knee again collapsing.

MRI torn ACL and ALL
Torn ACL and ALL

ACL and ALL Reconstruction

His MRI scan showed a clear ACL rupture and, given the significant instability that he had, I recommended an ACL reconstruction, from which he has done very well.

Because he was so significantly unstable I combined the ACL surgery with an anterolateral (ALL) ligament reconstruction using a double-gracilis graft. I used my technique of making a single socket on the femur and a complete tunnel on the tibia for the anterolateral ligament, and for the ACL quadrupled his semitendinosus which was a very nice graft in terms of size and diameter. I compressed this down using my own compression sleeve system and the surgery went extremely well.

He has made a very good recovery and I am delighted with how well he is doing at the moment. In fact Gareth represents a classic tale in the UK of a sportsman having a twisting injury and not getting an early MRI scan and referral through to a knee specialist, which is really what should be happening. Sadly, the average time to surgery in the United Kingdom after injury like this is 12-18 months. In Japan they consider patients to be chronic if the ACL is left untreated more than six weeks!

adrian wilson

Gareth's story highlights the importance of seeing a knee surgeon early after a twisting injury.

He had the classic tale of changing direction, hearing a 'pop' and feeling his knee go. This was last summer (2016).

The diagnosis was quite clear just from his story - a torn ACL - but sadly he was seen by his GP and then the MSK service and then by physios and was managed conservatively until quite recently (2017), despite episodes of frank giving way and an unstable knee with pivot.

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