Before surgery begins, the knee is carefully assessed to see if any other ligaments are damaged and to assess its range of motion and stability. This video demonstrates how unstable a knee can be after an anterior cruciate ligament injury.
Reconstruction is usually performed with hamstrings harvested from behind the patient's knee, through an incision on the inner anterior aspect of the knee below the joint.
Much of the rest of the surgery is carried out through arthroscopic techniques. The hamstrings are attached to the bones with pins and screws. Mr. Miles uses dissolving ones so they do not need to be taken out at a later date. This picture shows a hamstring graft in place as seen through the arthroscope.
The rehabilitation phase is vital. Initial work is on range of motion, followed by strengthening exercises. It can take a year to return to high level sports which involve 'cutting' (running and changing direction e.g. rugby, football, basketball)