ACL Injury / Rupture / Tear – Reconstruction Surgery – Perth

If you have suffered an ACL rupture in Perth you may require surgery depending on associated injuries (meniscal tears, cartilage injury, multiligament injury), your level of desired function (eg returning to football/soccer / netball) or ongoing pain and instability after a Physiotherapy muscle strengthening program. ACL reconstruction involves replacing the ruptured ligament with a tendon graft from your body (hamstrings, quadriceps or patella tendon). Rarely in paediatric cases, the ruptured ligament may be repaired without tendon grafting. This article is an overview of what to expect before and after ACL surgery. Acute ACL injury/tear is seen by Dr Daniel Meyerkort at Perth Orthopaedic every Friday. Priority access to MRI is available through SKG and PRC.

In which hospitals is ACL surgery in Perth done?

ACL reconstruction surgery in Perth is available in Private Hospitals including Hollywood Hospital, Bethesda and SJOG Subiaco.

The importance of Physiotherapy Prehab before ACL Surgery

A team approach between your surgeon and physiotherapist is essential to optimise your outcome after ACL reconstruction. Dr Daniel Meyerkort has a wide network of Physiotherapy colleagues in Perth to help optimise your ACL reconstruction surgery. In the initial 3 – 5 days post injury, rest, ICE, elevation and compression are useful to reduce pain and swelling. Most patients with ACL rupture benefit from a course of physiotherapy before surgery to regain their knee motion and muscle strength. This leads to a better result after surgical reconstruction. Certain knee injuries (eg ACL rupture with a displaced meniscal tear or multi-ligament knee injury) require surgery before physiotherapy, as a mechanical block in the knee will prevent your knee from regaining full motion. Your surgeon and physiotherapist in Perth will work together to plan an optimal prehab / surgery program for you and your injured knee.

Graft choice for ACL reconstruction – Perth Orthopaedic

The optimal choice of graft is hotly debated in the ACL literature. Common graft choices are hamstrings, quadriceps and patella tendon. The LARS ligament (synthetic) has fallen out of favour due to concerns over early failure. Other factors apart from graft choice can also influence the chance of long term success. Accurate tunnel placement and a large graft size (over 8mm in diameter) are the two most important factors associated with long term success. Below is an overview of the commonly used grafts

• HAMSTRINGS – Are the most common graft used for ACL reconstruction in Australia & Perth. One or both of the hamstrings (depending on size) can be harvested and prepared as the new graft. Commonly the hamstring tendon is folded over 4 times to gain sufficient diameter to form the new ACL. Many patients ask if they will be weaker or lack power as a result of the hamstring harvest. The effect is minimal (many high level AFL footballers, EPL footballers etc) have undergone hamstring reconstruction. It remains my preferred choice for most patients due to a high chance of success and low associated complications.

• PATELLA TENDON – The central 1/3rd of the patella tendon can be harvested with associated bone blocks on either side to form the ACL graft. Compared to hamstring graft, patella tendon has been shown to have a slightly lower rate of re-rupture. This is offset by higher long term rates of patellofemoral (knee cap) arthritis. Hamstrings remain my preferred graft choice due to the higher rate of knee-cap arthritis associated with patella tendon. Patella tendon is a useful graft choice for revision (redo) ACL reconstruction.

• QUADRICEPS TENDON – Recent interest in the use of the central part of the quadriceps tendon has surfaced in the orthopaedic literature. Similar functional results in short term studies have been demonstrated. In general studies have suggested quadriceps tendon graft have less pain but a higher degree of quadriceps weakness post surgery.

What happens during ACL surgery in Perth Private Hospitals?

Surgery is performed in Perth at Hollywood, Bethesda and SJOG Subiaco. The anaesthetist will talk to you about your anaesthetic. Most patients have a nerve block to a small nerve that supplies part of the knee to help with pain management after surgery.

A small cut is made over the hamstring insertion, just below the knee. This allows for the hamstring tendon to be harvested and prepared. A high volume of dilute local anaesthetic is injected into the hamstring harvest to help reduce your post operative pain. The remaining surgery is keyhole, two small cuts are made over the knee to introduce the camera (arthroscope) and micro instruments. The knee is carefully inspected and at this time meniscal surgery (repair) is performed if needed. The bony area for the new ACL is prepared and tunnels are drilled in the femur bone and tibia bone. The ACL graft is then passed through these tunnels and fixed into the bone.

What happens after ACL surgery?

For straightforward ACL surgery without meniscal repair, you will weight bear immediately and be allowed a full range of motion of the knee. If you require a large meniscal repair or associated ligament repair, you will require a hinge knee brace for the first 6 weeks and your weight bearing may be limited (25% body weight) for this period to allow the meniscus to heal.

Most patients spend one night in hospital however some prefer to go home the day of surgery. The first few days you will require regular pain medication and ice to reduce pain and swelling. Many patients find the GAMEREADY ice compression machine to be useful, we can organise a hire of this if you prefer this to standard ice. The physiotherapist will visit you and commence your rehab before you leave the hospital. Physiotherapy in Perth is essential for the first 12 months after surgery. Your physiotherapist will guide your rehab to return you to your best level of function. As a general rule in the first 6 weeks the most essential task is to regain full extension of your knee (be able to fully straighten). You will be seen around 10 – 14 days after surgery in our rooms for a wound review.

How Much Does ACL Surgery Cost in Perth?

Dr Meyerkort is a no gap provider for all health funds in Perth. This means you will have no out of pockets expense for your surgeon. Standard costs still apply for clinic visits/physiotherapy etc. As a general guide, the anaesthetist that we use regularly is either no gap or will charge a known gap (less than $500). An excess payable to Perth private / Hollywood Hospital, Bethesda hospital or SJOG Subiaco hospital may apply depending on your level of coverage.

Animated Video of ACL Reconstruction

Below is a good animation demonstrating how the tunnels are drilled for ACL surgery in Perth and then how the graft is passed and fixed.