ACL Rupture

Treatment, Graft Options, and Surgical Techniques

An anterior cruciate ligament (ACL) rupture is a significant knee injury commonly seen in athletes and active individuals.

It often occurs during pivoting, sudden stops, changes in direction, or trauma. The ACL is critical for maintaining knee stability, especially in sports that involve cutting and jumping. Dr Daniel Meyerkort, Orthopaedic Surgeon at Perth Orthopaedic & Sports Medicine, provides expert care in ACL rupture management, offering a tailored approach combining the latest surgical techniques, non-surgical options, and advanced rehabilitation protocols.

Symptoms and Diagnosis of an ACL Tear

A ruptured ACL often presents with a sudden popping sound, pain, swelling, and instability in the knee. Many patients report the inability to continue activity immediately after the injury. Diagnosis is confirmed through clinical examination (Lachman’s test, pivot shift) and imaging, particularly MRI scans, which also evaluate other associated injuries such as meniscal tears or bone bruising.

Non-Surgical Management of ACL Rupture

Non-surgical (conservative) treatment of an ACL rupture may be suitable for:

  • Older or less active individuals

  • Patients not participating in pivoting or high-impact sports

  • Those willing to modify their activity level

Non-surgical management typically includes:

  • Physiotherapy: Focused on strengthening the quadriceps, hamstrings, and gluteal muscles to stabilise the knee.

  • Bracing: ACL braces can help reduce instability during activity.

  • Activity Modification: Avoidance of high-risk movements or sports that may cause re-injury.

Although conservative treatment can be effective, it carries the risk of residual instability and secondary damage to menisci or cartilage over time.

Surgical Management of ACL Rupture

Surgical reconstruction is often recommended for:

  • Young, active individuals

  • Athletes involved in cutting or pivoting sports (e.g., soccer, AFL, netball)

  • Patients with associated meniscal or cartilage injuries

  • Those with persistent instability

Dr Daniel Meyerkort performs ACL reconstructions at leading facilities including Hollywood Private Hospital in Perth. Surgery is typically performed arthroscopically and involves replacing the torn ACL with a tendon graft.

Graft Choice in ACL Reconstruction

Selecting the appropriate graft is a crucial step in achieving successful outcomes. Dr Meyerkort discusses graft options thoroughly with each patient, balancing recovery, strength, and long-term success.

1. Hamstring Tendon Autograft

  • Involves using the patient’s own semitendinosus and gracilis tendons.

  • Pros: Smaller incision, minimal anterior knee pain, reliable healing.

  • Cons: Slight hamstring weakness, graft elongation risk in some cases.

2. Patellar Tendon Autograft (Bone-Patellar Tendon-Bone)

  • Harvested from the central third of the patellar tendon.

  • Pros: Strong bone-to-bone healing, often preferred in high-level athletes.

  • Cons: Risk of anterior knee pain and patellar fracture, longer recovery in some patients.

3. Quadriceps Tendon Autograft

  • Increasingly popular, especially in revision cases or high-demand knees.

  • Pros: Robust graft with minimal hamstring or patellar impact.

  • Cons: Slightly larger incision, limited long-term data compared to others.

4. Allograft (Donor Tissue)

  • Rarely used by Dr Meyerkort due to increased graft failure in younger, active patients.

  • May be considered in older, low-demand individuals or revision surgery.

Lateral Extra-Articular Tenodesis (LET)

To enhance rotational stability, especially in high-risk patients, Dr Meyerkort may perform a Lateral Extra-Articular Tenodesis (LET) in addition to ACL reconstruction. LET involves using a strip of the iliotibial band to reinforce the lateral side of the knee, reducing the strain on the ACL graft.

Indications for LET Include:

  • High-level pivoting athletes (e.g., AFL, basketball)

  • Generalised ligamentous laxity

  • Revision ACL surgery

  • Significant pivot shift on examination

Benefits of LET:

  • Reduced risk of graft failure

  • Improved rotational stability

  • Enhanced return to sport outcomes

Risks of LET:

  • Increased operative time

  • Temporary lateral knee pain or tightness

  • Rare over-constraint if not tensioned properly

Rehabilitation After ACL Reconstruction

Dr Meyerkort collaborates closely with physiotherapists to develop structured rehabilitation protocols:

Phase 1: Early Recovery (0–6 weeks)

  • Focus on reducing swelling, regaining range of motion, and restoring quadriceps activation.

Phase 2: Strengthening (6–16 weeks)

  • Progressive strength exercises targeting the knee and hip.

Phase 3: Functional Training (4–6 months)

  • Balance, agility, and sport-specific drills.

Phase 4: Return to Sport (6–12 months)

  • Testing strength, hop function, and psychological readiness.

  • Return-to-play decisions are based on objective assessments.

Dr Meyerkort also offers accelerated rehabilitation protocols in selected athletes, supervised closely to ensure graft protection and optimal function.

Risks of ACL Surgery

While ACL reconstruction is a commonly performed and successful procedure, like all surgeries, it carries potential risks:

  • Infection

  • Bleeding or blood clots

  • Graft failure or stretching

  • Knee stiffness

  • Anterior knee pain (especially with patellar grafts)

  • Persistent instability or re-injury

Benefits of ACL Surgery

When performed by an experienced surgeon such as Dr Meyerkort, ACL reconstruction can deliver:

  • Restoration of knee stability

  • Prevention of secondary meniscal and cartilage damage

  • Improved confidence in high-level activity

  • Higher rate of return to sport

  • Long-term protection of knee joint health

Why Choose Dr Daniel Meyerkort – Perth Orthopaedic & Sports Medicine

Dr Daniel Meyerkort is a an orthopaedic surgeon specialising in knee injuries, sports medicine, and minimally invasive arthroscopic techniques. Based at Perth Orthopaedic & Sports Medicine Centre and operating at Hollywood Private Hospital, Dr Meyerkort is committed to patient-centred care and evidence-based treatment.

Patients across Western Australia, including those in Bunbury, Geraldton, Kalgoorlie, and Broome, can access Dr Meyerkort’s expert care via Telehealth and in-person consultations in Perth.

Personalised Orthopaedic Care in Perth

If you’ve experienced a knee injury or ACL rupture, early assessment is vital to prevent further joint damage and plan for the best outcome. Contact Perth Orthopaedic & Sports Medicine Centre to book a consultation with Dr Daniel Meyerkort and take the first step toward a stable and active future.