Anterior Cruciate Ligament

Anterior Cruciate Ligament InformationShoulder InformationPatient InformationFile DownloadsvideosBiodex

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Welcome to the Sports Injury Surgery website which is administered by Mr Breandán Long FRCSI FFSEM.

Mr Long specialises in Anterior Cruciate Ligament Surgery and Shoulder Surgery. This site has been developed specifically for the general public and sports persons. You will find relevant information about Sports Injuries and Rehab. Anyone can contact us for more information. Mr Long is based in Aut Even Hospital, Kilkenny and Bon Secours Hospital Limerick at Barrington’s. He also has consulting rooms in Coote’s Lane, College Road, Kilkenny where the Sports Injury Surgery clinic is based.

Phone and Video Consultation A preliminary consultation can be arranged by phone and a video call over WhatsApp. To set this up please contact the office to arrange a time. You can send in your MRI scan first and Mr Long can look at it for you. A full consultation can then be arranged to discuss a treatment plan and surgery if this is required.

ACL return to sport criteria – 6 things to consider

There is no international consensus on what are the criteria for return to play after an anterior cruciate ligament reconstruction. These are 6 things that I like to address and discuss with the patient. There are lots of other factors that could be considered but this is what we do.


  1. The Patient

The knee itself must feel right to the patient. The patient must have confidence in the knee and feel that it is stable. Only the patient knows this. This is something that improves with time and with good rehab.


  1. Balance

This is often neglected or poorly rehabilitated. The majority of patients 6 months after ACL surgery have poor proprioception. They perform poorly on whatever hop test is given to them and they have an inability to stand on the affected leg for more than 10 seconds with their eyes closed.

We perform a maximum lateral hop test for distance. To pass this, one leg must be within 90% of the other.

It does not really matter what test you use but it is an important criterion to evaluate.


  1. Strength

The ACL patient must have recovered good muscle function in both legs.

We perform a Biodex Isokinetic test. There must be less than a 15% deficit between the legs and both legs must have adequate strength.

We believe that strength cannot be accurately measured unless a computerised system is used. You are deluding yourself if you do not measure this properly.


  1. Knee examination

Ideally the knee will have a full range of movement, good stability and no effusion.

If the knee has an effusion then a return to sport is delayed.

If there is a lack of movement at 6 months then it is unlikely to return fully.

If the knee is very lax at 6 months then it is unlikely to get much tighter. However it could still function with good stability.


  1. Sport Specific Skills

These are not measured at the follow up clinic. The athlete works on these themselves. The athlete is made aware that they will need to do skills training as anyone would do if they were out of sport for a long time, injury or no injury.


  1. Aerobic Fitness

Again this is not measured in the clinic. The athlete understands what level of fitness is required to play their sport.

It is explained to the athlete that fatigue is a major factor in injury and awareness of tiredness when playing is very much delayed.

It is best to return to sport by playing the last 10 minutes of games, then the last 20 minutes and then the second half to build up endurance.


Anterior Cruciate Ligament Surgery

There is a lot of information on anterior cruciate ligament tears. If you have a tear and need information have a look at the specific ACL section. We are including new information in this area as this is an evolving field. The last 10 years has seen both significant and subtle changes in the surgery technique. These will benefit the patient. There are a vast amount of published studies on the ACL. We have tried to keep the information simple and relevant. We can discuss various graft options with you. You have probably heard of hamstring and patellar tendon grafts. Now the 5 strand hamstring graft is the first choice for most patients. It is probably 20% stronger than the 4 strand hamstring graft and we are using it in the majority of our patients. Please have a look at an article on the 5 strand hamstring ACL graft here. It is also possible to use the Quadriceps tendon as an alternative graft. This technique can be very useful in revision ACL surgery where the original graft is torn. In cases of revision / redo anterior cruciate ligament surgery the patella tendon can be used if the hamstrings were used the first time or vice versa. There are lots of options including taking a graft from the other leg. This is a nice idea because now a 5 strand hamstring tendon graft can be used and this appears to be proving to be particularly strong. We are also aware of the renewed interest in the antero lateral ligament of the knee and we are keen to repair it when indicated. Click Antero Lateral Ligament here for a video by Dr Steven Claes on this important addition to our knowledge of anterior cruciate ligament injury.

The most important part of the rehab phase is from 4 months after surgery until you return to sport. This is a time where some patients can reach a plateau and not achieve full strength. It can be difficult to get the time to do what is needed. Also there is a certain amount of possible boredom and complacency setting in. That is why we think that patients after ACL surgery should not overdo rehab in the first 3 months. There is a real chance of getting a bit burned out too early. The graft needs about 3 months to bed in and become attached to the bone. Then it can be safer to push it a bit harder. We do Biodex isokinetic tests at 4 months and 6 months after surgery. These tests give you an accurate picture of how strong your hamstrings and quadriceps muscles really are. We can then advise you how much you can push it and how hard you need to go. We can also advise you when you can start joining in the drills with your team and get back to sports specific training. As part of the follow up consultations your knee will be examined and in conjunction with you test results we can set realistic goals together.

Here is the quick link to our comprehensive post op ACL surgery rehab programme.

Shoulder Surgery

You may also need information on shoulder surgery, stabilisation or rotator cuff repair. There is a specific section on the shoulder. We can give you information on keyhole surgery for common shoulder conditions such as shoulder instability, rotator cuff tear, shoulder impingement and AC acromio-clavicular joint arthritis. Shoulder dislocation and in particular acromio-clavicular dislocation are particularly common especially in hurling and football. In these cases the ligaments holding the joint in place are torn. They may recover in time with physiotherapy but in some cases surgery is required. Surgery can return and reattach the ligaments to their correct position.

Shoulder pain is very common and is often termed wear and tear. It increases with age. However it can be equally seen in those with heavy workloads and those who are relatively sedentary. Through a combination of rehab exercises and injections a lot of patients can achieve good function and reduced pain levels. For those with significant rotator cuff tears and those that do not improve, arthroscopic surgery can transform a patient’s life. A patient may go from having pain nearly all the time and especially at night to being pain free. Over time the power and function can return so that a patient can get back to work and sport.

Please feel free to contact us with any query you have. No matter where you are we will try to help you. In all cases we will arrange the appropriate investigation which is usually a MRI scan. We have quick and easy access to the MRI scanners in Aut Even Hospital and in Barrington’s Hospital but we can arrange a scan in any MRI unit that is convenient to you. We also have the facility to view the images online. This cuts down greatly on any delay in getting the results to you and allows us to plan your treatment quickly.

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