Anterior Cruciate Ligament (ACL tear) & Ligament injuries

The Anterior Cruciate Ligament (ACL), is one of 4 major ligaments that stabilise the knee joint. An ACL tear can result from injuries sustained in sports and skiing activities, and results in moderate swelling within a few hours of the injury.
Secondary damage can occur to the cartilage at the time of the injury or later as the knee keeps giving way and puts extra strain on the knee joint.

The injury usually occurs during activities such as football, rugby, skiing, squash or other twisting manoeuvres. Patients usually feel something “go” or “snap” in the knee when the ACL tears.
The knee swells within 2-4 hours usually but not always. It is important to see a physiotherapist or your doctor soon and seek referral to a specialist in ACL injuries.
Early rehabilitation of the knee is targeted at reducing the swelling with Rest, Ice, Compression with a tubigrip bandage or ACL knee brace and Elevation of the leg when resting (RICE).

The knee may give way on a recurrent basis and if this is a problem after adequate physiotherapy, then use of an ACL knee brace and or early surgery is recommended before secondary injury to the cartilage takes place.
The knee will have laxity if the ACL tear is complete and this can be detected by examining the knee by trained and experienced practitioners familiar with the clinical tests to detect this injury. The tests may be inaccurate if the knee is very sore and cannot be adequately relaxed for the purposes of examination.
Special scans such as an MRI scan will help with the diagnosis of an ACL injury
ACL tears may be partial or complete. A partial tear may heal and not require ACL reconstruction

Reconstruction of the ACL for a complete ACL tear is a highly successful procedure and is performed Arthroscopically (Keyhole), necessitating only 24 hours in hospital usually.
Rehabilitation after ACL reconstruction is under supervision of trained specialist physiotherapists, in close liaison with the surgeon, and is progressive for 6-9months, with an aim to return to sports at around 1 year post surgery. Upon initial return to sports, wearing an ACL knee brace can reduce the risk of re-injury to the graft, which may still not have full strength even at 1 year.

2 Different grafts are in common usage, the BTB - bone tendon bone - Patella Tendon (Kneecap graft), and the Hamstrings graft. Depending on patients’ pre-injury activities, occupation, and future needs, appropriate grafts are chosen for the individual.·
Precise surgical technique and accurate tunnel placement dictate the success of the procedure.
Surgeons performing the procedure infrequently often have poor results compared to experienced surgeons performing higher volumes of ACL reconstructions.
Mr Siddiqui is fully trained and has over 20 years of experience in the procedure and has performed large numbers of this surgery (over 1000 procedures), and revising failed surgery performed by other surgeons in the Huddersfield, Halifax, Dewsbury and West Yorkshire areas.
Best practice guidelines produced by BASK are adhered to.
An audit of ACL reconstructions performed by Mr Siddiqui revealed 97% accuracy in tunnel placement, and over 90% achieving good to excellent results.·

Other Ligament injuries include Medial Collateral (MCL), Posterior Cruciate (PCL), and the Posterolateral Corner (PLC).
Although less common, and not always requiring surgery, it is important to treat these injuries correctly from the time of injury to reduce the risk of long term malfunctioning of the knee.
These injuries can be part of a very high energy injury or knee dislocation, which can result in nerve and artery damage in addition. They are often sent to and treated at major trauma units where orthopaedics, plastic surgery and vascular surgery teams can work in combination.