KNEE LIGAMENT SURGERY

“I was ski racing in January 2017 and regularly go ski touring so, it’s safe to say that the knee has surpassed every test so far.”

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Anterior cruciate ligament (ACL) surgery

Not everyone who has an ACL injury needs to have surgery. In some cases, it’s possible to regain knee stability with a personalised course of physiotherapy, along with wearing a knee brace when taking part in sport. However, most people have to modify their activities to avoid their knee giving way and pain. If you compete at a high level, where you put additional stress on your knee, you are more likely to need a surgical procedure. If your knee frequently gives way during normal everyday activities, this can cause further damage.

anterior cruciate ligament (ACL) reconstruction
ACL reconstruction involves removing existing tissue and then carrying out a graft. This uses either the patient’s own tissue (autograft), usually from the hamstrings or patella tendon, or donated human tissue (allograft) to make a new ACL. Tunnels are created in the shin and thigh bone so that the graft can be fixed in place. It’s usually carried out as a day case procedure using keyhole surgery. Adrian has helped to pioneer the new “All Inside ACL technique” and is considered one of the leading surgeons globally to carry out this less invasive technique for reconstructing the Anterior Cruciate Ligament.
anterior cruciate ligament (ACL) repair
Using a technique that Adrian has helped to pioneer and using surgical instruments that Adrian has helped to design, it is now possible to repair the ACL by stitching the torn ends of the ligaments together and creating an ‘internal brace’ of fibre tape that holds the joint in the correct position. The fibre tape is passed through tiny tunnels drilled into the bones to fix the ligament securely and is so strong that patients are able to walk normally and carry out their daily activities only a few days after surgery. It is usually carried out as a day case procedure using keyhole surgery

What are the advantages of anterior cruciate ligament (ACL) repair over reconstruction?

The main advantage of ACL repair is that, once the tissue has had time to heal, you can get back to your normal activities, including sports such as football, tennis or rugby.

Healing is very fast – if successful, there is full healing at three months which is very different to the standard ACL replacement or reconstruction surgery which takes at least a year before it is strong enough to allow you to take part in any sports that involve twisting the knee.

Recovery period - anterior cruciate ligament ACL repair

Why has this only been available recently?

Over the last five years, the instruments and implants that Adrian uses to fix ligaments have become more sophisticated, and he has adopted a new technique to carry out this surgery that was pioneered by Professor Gordon MacKay from Glasgow. Adrian has developed this technique further with Gordon, helping to designing the tiny instruments used to drill tunnels into the bones through which the fibre tape can be passed.

How long does it take to recover from ACL repair surgery?

Full healing takes only around three months. This is very different to conventional ACL replacement or reconstruction surgery which takes a minimum of 12 months for a new ligament to become strong enough for any twisting sports.

What is the long-term impact of ACL repair surgery on activity level/sports?

Repairing rather than replacing the ACL enables patients – even elite sportsmen and women – to return to their usual activities within a few months.

New procedures for treating anterior cruciate ligament (ACL) injuries

Adrian has pioneered a number of procedures to treat ligament injuries, including new techniques for anterior cruciate ligament (ACL) reconstruction.

The All-Inside anterior cruciate ligament (ACL) technique

Adrian was responsible for the development of this new type of surgery back in 2010 as well as designing the instruments to carry out the operation. There is now been popularised to the point where it’s become the gold standard globally for ACL surgery. Adrian was there from the very beginning performing the first live demonstration of this procedure and working with the engineers at Arthrex to develop the tools and the technique to make this the successful procedure that it’s become.

The advantage of the All-Inside technique is that it involves taking just one hamstring tendon as opposed to two, so it preserves soft tissue. And, rather than drilling complete tunnels, Adrian creates sockets in the joint, preserving more of the bone. He is frequently asked to perform live surgery to demonstrate this procedure.

Anterior cruciate ligament (ACL) repair

Adrian has helped to pioneer a new ACL repair technique that was introduced by his friend and colleague Gordon Mackay, who is based in Glasgow. The advantage of this new technique over traditional reconstruction is that patients are able to recover more quickly and get back to their sport sooner than with traditional ACL reconstruction surgery.

Adrian has a particular interest in carrying out this type of ACL repair in children and has the largest experience in the world currently with this technique in children, having pioneered the instruments and technique to perform this successful procedure. His methods have now become routine practice among leading knee surgeons, many of whom Adrian has trained in his techniques.

Anterolateral Ligament reconstruction (ALL procedure)

When the ACL is torn, the anterolateral ligament (ALL) is often torn at the same time. It’s now recognised that reconstructing this tendon at the same time as ACL surgery minimises failure (previously a major concern of this type of procedure, resulting in the need for reconstruction surgery to be repeated) and improves the results.

In very serious ACL tears, it’s not uncommon to need to carry out an additional procedure to the outer or lateral side of the knee. Adrian worked with leading European knee specialists to develop a new procedure to carry out this lateral reconstruction and reconstruct the torn ALL.

The five-year clinical results show that when this the ALL procedure is carried out in addition to an ACL reconstruction the failure rate can be reduced from 5% to 1%.

Working in collaboration with other leading sports knee surgeons, including Drs Steven Claes and Johan Bellemans from Belgium and Dr Bertrand Sonnery-Cottet from Lyon, Adrian has helped to develop an innovative procedure known as anterolateral ligament (ALL) reconstruction. This type of surgery, known as the ALL procedure, helps reduce further injury and improves the outcome of ACL surgery. Carrying out an ALL procedure in combination with ACL surgery has, in some cases, been shown to significantly reduce failure rates and improve the outcome.

What does it involve?

Adrian uses a tiny drill to create tunnels between the thigh and shin bones in the joint; the torn ALL isn’t removed but the new ligament is fixed into the tunnels using ‘swivel locks’ – plastic devices to fix ligament to bone.
The new technique can be performed on both adults and children. The additional ALL surgery takes around 20 minutes and the recovery is similar to that of traditional ACL reconstruction surgery.

Professor Adrian Wilson
“We haven’t seen any significant complications in patients who’ve had anterolateral ligament (ALL) replacement as part of ACL reconstruction. The knee joint recovers a full range of movement and there is no sign of the instability that can sometimes occur after a traditional ACL reconstruction.”

Fibre tape reinforcement for ligament surgery – “Internal Brace Reinforcement”

Adrian has gained a world reputation for his technique of using fibre tape for ligament reinforcement. He uses the tape to reinforce small grafts during surgery. It has become common in ACL surgery and is now a routine for many elite surgeons in the US and Europe who have learnt and adopted Adrian’s technique of “Internal Brace Reinforcement”. It is especially beneficial in posterior cruciate ligament reconstruction (PCL) surgery and revisions. The fibre tape acts as an internal scaffold and helps the ligament to heal and not stretch in the critical first three months following surgery.

This technique is now used around the world by many leading sports knee surgeons. It is especially useful in elite athletes who play contact sports such as rugby and football. Adrian is frequently asked to speak about this and his other innovations at meetings around the world.

Posterior cruciate ligament (PCL) surgery

If you need to have PCL reconstruction surgery, a graft is made either from your own tendons or donor tendons and passed through pre-drilled holes in the thigh and shin bones, using X-ray guidance. It’s then fixed with screws. In most cases, PCL reconstruction is carried out alongside repair to other ligaments. Adrian was the first surgeon globally to use the “ALL inside technique” for PCL surgery. This has now become the gold standard in many leading units such as the Mayo clinic in Rochester, USA where the sports knee surgeons now use this as a routine. Again it has all the benefits of being less invasive and with Adrian’s Internal Brace reinforcement has transformed the outcome of this surgery.

Posterior cruciate ligament (PCL) surgery in children

In some cases, it may be possible to re-attach the bone fragment along with the ligament using keyhole surgery. However, ligament re-attachment can only be carried out in the first week or two after an injury. If it’s left longer, it may need to be reconstructed in the same way as for adults.

Posterolateral corner (PLC) repair and reconstruction

The PLC is usually injured alongside other ligaments, often as part of a multi-ligament injury along with one or both of the cruciate ligaments. It’s recommended that the PLC should be repaired within 2-3 weeks of the injury. If repair isn’t possible, the ligaments can be reconstructed using tendon grafts.

Adrian has developed his own minimally invasive technique to reconstruct the PLC using a combination of one hamstring tendon either from the patient or from a donor and combining this with fibre tape to reinforce the repair. This method is now frequently used by other sports knee surgeons around the world. This technique is now referred to as “internal Brace reconstruction” and Adrian has applied it to a number of different techniques around the knee for ligament reconstruction.

Multi-ligament surgery in the knee

In some cases, following a multi-ligament injury, two or more ligaments can be reconstructed during one procedure. However, the planning and timing of surgery is important, along with following your personalised rehabilitation plan afterwards to maximise the chances of a good recovery.

As an expert in this difficult area of surgery, Adrian frequently sees patients who are referred to him by other knee surgeons. Adrian uses his own Internal Brace reconstruction technique, where he combines fibre tape with ligament reconstruction to reinforce the ligament and improve long term results. This technique has revolutionised the outcome and recovery of multi-ligament surgery and is used by surgeons around the world in preference to traditional reconstruction techniques.