Internal Bracing and Synthetic Grafts in ACL Surgery

All surgery carries some residual risk, similar to how buying a car involves a small residual risk of a road accident that is rarely front of mind. The reassuring fact is that all the major blood vessels and nerves sit outside the knee and shoulder joint capsule, so as long as the anatomy is well understood and the surgery carefully planned, arthroscopy is one of the safest procedures available. Most arthroscopies are done as day-care procedures, with patients going home the same day.

Hip arthroscopy is a little different because the hip is a deeper joint, but designated portals developed over many years of anatomical study make it safe as long as a surgeon sticks to those landmarks. Labral repairs, loose body removal and cartilage surgery can all be done through the hip arthroscope. Surgeons early in their hip arthroscopy experience can use a safer mini-open approach, a small skin incision leading to the joint before introducing the scope.

With the newer all-inside technique and fiber tape augmentation, patients can weight-bear from day one using a walking aid for three to four days until pain settles, though supervised physiotherapy is still required. Full graft incorporation into bone takes about six weeks. Running and jogging can resume at three months, and return to sport is not advised before three months, since many failures happen when patients return to pivoting activity too soon.

For the knee, heavily loaded squats, especially with all the focus on upper body and inadequate lower limb conditioning, high-speed incline treadmill running, twisting exercises on a disc twister, and overloaded quadriceps extension machines are the most common causes of ACL ruptures and quadriceps or patellar tendon injuries. For the shoulder, wide-grip flies taken too far posteriorly can stress the joint, especially in anyone with a prior subluxation history. The most important message is to stop when the body signals pain rather than pushing through it.

A thorough history of the mechanism of injury tells a doctor about 70% of what they need to know, since mild pain from ordinary walking is very different from a pop felt during sport followed by an immediate fall. Persistent pain despite conservative treatment should not be dismissed as non-compliance; something is usually being missed and warrants an MRI. Any significant mechanism of injury deserves a low threshold for imaging without delay, since ACL repair rather than reconstruction is possible if the patient is seen within two to three weeks of injury. Once an MRI is available and there is uncertainty about the findings, a second opinion through Jivo can confirm whether the patient needs conservative treatment, local surgery, or referral to Artemis.

A fiber tape is threaded alongside the graft and fixed under tension, tighter than the graft itself, so it absorbs the first load rather than the tendon graft. This protects the graft from loosening, weakening or elongating during the first three months of healing.

They are used for patients with multi-ligament injuries where tendon graft sources are limited, or patients who do not want a tendon harvested. Made of polyethylene terephthalate, they test as strong as or stronger than standard tendon grafts, avoid donor site problems, and allow faster recovery.