First, a detailed medical history is taken with regard to any accident mechanism, pain and subjective instability. Other aspects such as professional activity and sporting demands are also ascertained. This is followed by a detailed physical examination with clinical testing of knee stability and any concomitant injuries. An MRI scan is mandatory in the case of a suspected ACL rupture and is always carried out before treatment is planned.
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First, a diagnostic arthroscopy of the knee joint is usually performed to confirm the indication (tear of the ACL) and to assess all structures of the knee joint (meniscus, cartilage, etc.). An autologous tendon (semitendinosus tendon, possibly + gracilis tendon, alternatively quadriceps strip) is then removed. The tendon is then prepared and fitted with sutures and a fixation system. A hole the size of the removed tendon is then drilled in the anatomically correct position on the thigh and lower leg and the prepared tendon is then pulled in and fixed to the thigh (femoral) and lower leg (tibial). If other pathologies requiring treatment are discovered during the arthroscopy, these are also treated during the same operation (e.g. meniscus tear).
Postoperatively, we recommend partial weight-bearing of the operated leg for approx. 2 weeks (in the case of isolated ACL plastic surgery); full weight-bearing can then be resumed if the knee joint is free of irritation. An orthosis is prescribed for approx. 6 weeks postoperatively; mobility is not explicitly restricted postoperatively, but is gradually increased with physiotherapy exercises. From week 7, an orthosis is no longer necessary and strength training with full weight-bearing and resistance can be performed. If, for example, a meniscus suture is necessary in addition to the ACL plastic surgery, the period of partial weight-bearing on crutches is extended to 6 weeks; a longer restriction of flexion is also necessary to allow the torn meniscus to heal (see meniscus suture).
With continued muscular exercise and a gradual increase in weight-bearing, a return to everyday activities can be expected after approx. 8-12 weeks. Further weight-bearing, especially sports, is then carried out individually in close consultation with the physiotherapists treating the patient, whereby knee-friendly sports such as cycling or swimming (crawl) are possible again at an early stage. A return to full sporting activity (including team sports such as soccer or handball) can be expected after 10-12 months, whereby specific return-to-sports testing is useful in advance.