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Anterior Cruciate Ligament Reconstruction (Specialist Prof. Siebold)

The anterior cruciate ligament (ACL) is in the middle of your knee joint. It is the most important knee stabilizer and a very important neurologic knee "sensor". Rupture of the ACL leads to instability, sensory loss and inability to perform stenous stop and go sports (e.g. soccer, basketball, tennis, squash, gymnastics and more). Instability, pain and swelling may also affect activity of daily living and work.
"Giving way" of the knee may lead to additional injuries to the meniscus and cartilage, which significantly increase the risk for the development of early osteoarthritis. Sports may no longer possible.
Therefore the international consensus is to stabilize the knee by an ACL-reconstruction to protect the meniscus and cartilage and to restore knee function.

ACL surgery: "Menu a la carte"


Our goal is to offer an individual ACL reconstruction to each patient. Therefore we use different tendons depending on the patients need. The semitendinosus tendon is a very elegant graft to perform an anatomical strong flat or double-bundle ACL reconstruction. The patella tendon is a very good graft for e.g. soccer players for fast return to sports. The quadriceps tendon is a strong and ""multitalented" graft, too.
In case of ACL remnants or a partial ACL tear Prof. Siebold developed a special augmentation technique to .preserve remnant stability, prorioception and vascularisation. He uses the semitendinosus tendon and performs a double bundle ACL reconstruction within your ACL remnants. This highly advanced ACL technique brings very good stability results and restores good proprioception, which is very important for high level sports activity.

Prof. Siebold is an international expert for ACL anatomy and reconstruction in adults and kids.He performed approximately 3000 ACL reconstructions using a variety of indduring the last 15 years. He is international guest and visiting professor to many ACL meetings and instituts around the world, author of many publications on ACL anatomy and reconstruction and author of a surgical book on "ACL Reconstruction" (Springer Verlag 2013, Heidelberg, New York)

Which tendon is the right one for my knee?

In young and/or professional soccer players and other competitive athletes we prefer to use the patella tendon. The two bone blocks on each side of the graft enable an ingrowth within 8 weeks and a premature return to the game after aproximatly 6-7 months. The downsite of this ACL reconstruction can be the pain or temporary numbness from the removel area beneith the knee cap. As a result this technique is not well suited for kneeling work, e.g. floorers, kindergarten teachers, tilers etc..

The hamstring tendons are an exellent and popular alternative to the patellar tendon. Nowadays, the stronger semitendinous tendon is our first choice so the gracilis tendon can be spared. The advantage of that is that the popliteal tendon removal usually creates no problem at the sampling point and is well tolerated. Furthermore the tendons are able to regrow to a certain extend within one year.
We use the semitendinesus tendon to reconstruct the two ACL parts due a double boundle technique or to perform a partial reconstruction also known as augmentation.

Depending on the type of sport and patient the middle third quadriceps tendon transplant has become very popular. It is also an execellent ACL replacement but requires one additional incision above the knee cap. This kind of ACL reconstruction is a very good solution for patients with kneeling work or sport types.

Finally, we offer the option to use a donor tendon (allograft) for the ACL reconstruction. This tendons must be ordered at tissue banks. Allografts especially are used within comlicated revision surgeries and multiple ligament injuries.

How does the treatment look like?


Timing
When the ACL rupture is diagnosed physiothery should be started as soon as possible to regain range of motion of your knee and to reduce swelling and pain. The pain usually settles after some time, the instability stays. An ACL reconstruction can be performed anytime after the injury. However a very important requirement is, that you can move your knee from extension to about 90° without much pain.

Appointment
You can send a CD with your MRI pictures of your knee with a history what happened to Prof. Siebolds hands at the HKF at ATOS Hospital Heidelberg. He will have a look at the pictures and will let you know about the possible treatment. A cost estimation will be send to you. If you want to proceed, you have to make an appointment for consulting and Prof. Siebold will see you personally. The surgery can usually be performed during your visit some days later.

Stay in hospital and physiotherapy
Usually the stay in hospital is at least 2-3 days up to 1 week after surgery. Full weight bearing will be allowed after 1-2 weeks, free range of motion from the beginning.
The patient will be mobilized on crutches, physiotherapy will be performed on a daily basis. After discharge it is possible to continue physiotherapy in our outpatient department. The flight back to your country may be possible after 4-5 days.

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