ACL Anterior cruciate ligament Reconstruction is a kind of knee surgery to replace the ACL, usually using a ligament or a muscle from another part of your body.
The ACL is a group of stringy tissue that helps to balance your knee. Tear or sprain of ACL one of the most common form of knee injuries. Most of them happen when playing sports (around seven out of ten ACL injuries). They occur usually when you slow down instantly while turning or may be while sidestepping at the same time. Basketball, netball, rugby, football and skiing are some of the sports that are mostly prone to causing ACL injury.
Physical Conditions that need an ACL reconstruction?
Your doctor is likely to recommend a reconstruction of your knee if it is unstable and if you’ve torn your ACL in instances where you:
- Earlier played a lot of sport and want to start playing again
- Have an active job, which includes heavy lifting or where it would be unsafe to have an unbalanced knee
- Have other injuries to your knee
You’re at risk of osteoarthritis later in life, if you have knee injuries that also means that your surgeon may also suggest:
Good Alternatives to ACL Reconstruction
Physical Therapy Exercise and Support
In a few cases ACL tear may not require a surgery to restore it. A few physiotherapy, exercises and a hinged knee brace can provide your knee all the support. Even doctor may suggest this type of treatment in case:
- Knee is stable
- Ligament is partially torn
- A lot of strain goes on to your knees as you don’t play sports or do no physical activities due to ageing.
ACL reconstruction usually is not done immediately. In instances where knee doesn’t recover adequately with physiotherapy and an exercise regime a surgery can be done several months later as well. Nearly 40% people treated like this may not require an operation. Those who do still need a surgery have outcomes that are just as good as those underwent a surgery within a few weeks of their injury.
Option of undergoing an immediate surgery depends on:
- Whether the other knee damages that you may have need surgical restoration
- Time interval within which you are considering getting back to a sport activity or work
For more information, speak to your doctor. They’ll be best placed to advise which treatment options are most suited to your individual situation and needs.
Groundwork for ACL Reconstruction
To allow any swelling to go down as much as possible and any stiffness in your knee to be resolved your surgeon may defer the operation. By the time of having surgery It’s best if you full range of movement in your knee pain-free too. Otherwise, the outcome may not be as good as it could possibly be.
It varies from person to person that timing of their operation which is ideally to be performed at least three weeks after your injury. Physiotherapy might be advised by your Surgeon during this time. Also ensuring you can move your knee as fully as possible, exercises will help:
- To reduce swelling
- To strengthen surrounding muscles
- Your recovery after surgery
As a part of the preparation for operation, your surgeon may ask you to stop smoking (if you do) as Smoking intensifies the risk of developing a chest and wound infection, which can slow down your recovery. Also, Contraceptive pill, as it can intensify your risk of blood clots, you may also be asked to stop consuming.
In case there are Cuts and scratches below the knee, your surgery may be delayed until they’ve healed as they increase your risk of developing an infection after surgery. So the main reason why surgeon may ask you to stop shaving your legs up to six weeks before your operation.
Your surgeon and anaesthetist will discuss with you on your procedure in advance. They’ll clarify any queries you may have and inform you what to expect. Make sure you do ask questions that you seek clarity on, so you know what will happen. A list of questions ready to be asked may help. Once you’re satisfied that all your questions have been answered, you sign a consent form, giving your permission for the procedure to go ahead.
Things to know during an ACL Reconstruction?
ACL reconstruction is carried out with a general anaesthetic or a spinal anaesthetic. You’ll be asleep during the operation if you have a general anaesthetic. In recent days, this kind of surgery is often performed as a day case, so you don’t visit the hospital until the day of the surgery and return home the same day.
Before the Surgery, you’ll meet your surgeon to discuss your care. It may vary from what’s defined here as it will be designed to meet your individual needs.
Your surgeon will examine your knee, after you have had the anaesthetic to check how badly your ligament is torn and if any other tendons or ligaments have been damaged. it’s easier to do a very thorough examination when you are completely relaxed, even though they would have examined your knee before this.
ACL reconstruction is keyhole surgery, meaning it’s done through several small cuts. Your surgeon will make these cuts in the skin over your knee. Knee arthroscopy the use of an arthroscope – a thin, flexible tube with a light and camera on the end of it to see inside your knee is performed here.
A Graft is usually a piece of tendon that is put in place of the injured ACL.ACL reconstruction involves replacing your torn ligament with a graft. In ACL, it acts as scaffolding for a new ligament to grow along.
First your surgeon will remove the piece of tendon to be used as the graft.
The graft is usually made from part of a tendon in another part of your knee, for example:
- Hamstrings, which are tendons at the back of the thigh
- The patellar tendon, which holds the kneecap in place
Graft from a donor is also used sometimes by the surgeons. This is called an allograft and will be collected before your surgery. You’re most likely to have a donor graft if you’re having further surgery to an ACL repair. You can find out more about grafts used in ACL reconstruction in our FAQs below.
A tunnel will be drilled through your upper shin bone and lower thigh bone. This means the graft can be put in almost the same place as your damaged ligament. Then the Surgeon will put the graft into the tunnel, attach it to your bones and fix it in place, usually with screws or staples. These are normally left inside your knee permanently. They will ensure there is enough tension on the graft and that you have full range of movement in your knee, before completing the operation. Then they’ll close the cuts with stitches or adhesive strips.
This operation will usually last between one and three hours.
What to expect post this surgery
You’ll be able to go home after the anaesthetic has worn off since this operation is often performed as a day case. But, you may need to stay in hospital overnight if you’ve had a general anaesthetic.
It may take several hours before the feeling comes back into your treated knee after a local anaesthetic. Special care is needed to avoid bump or knock the area by you. As much as possible It’s best to keep your leg elevated. You can have painkillers if you feel necessary.
You’ll have dressings over the small wounds around your knee. You will be advised by the nurse about caring for your healing wounds before you go home.
A physiotherapist will come and see you and help you up. They’ll give you crutches and show you how to use them. They may also give you a knee brace to give some support to your joint as it heals, although not all surgeons recommend these. There isn’t really any evidence that a knee brace will help to prevent further injury or that it will help you to recover after ACL reconstruction or You’re more likely to have one if you have non-surgical treatment for an ACL injury. See our FAQs below. for information on knee braces and returning to sport.
It’s safe to put weight on your leg as soon as you’re able to get up, but it is easier to use crutches to start with.
Some exercises will be given by your physiotherapist, to do while you recover from the surgery. Please follow the advice of your physiotherapist and surgeon as the amount of physiotherapy people need varies.
You may be given a date for a follow-up appointment before you go home.
You must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours post General anaesthesia since it temporarily affects your co-ordination and reasoning skills. You should try to have a friend or relative stay with you for the first 24 hours after your operation.
Recovery from an ACL Reconstruction
Usually it may take up to six months to make a complete recovery from ACL reconstruction surgery. But to begin with, it’s important not to do too much. Your leg should be kept erect when you’re not moving around or doing your exercises. Avoid too much standing or walking. You’ve overdone it, if your knee starts to swell.
It takes about two weeks after ACL surgery to fully straighten your leg and bend it to 90 degrees and mainly to be able to walk without crutches.
You may be able to go back to work four to six weeks after your operation if you have a desk-based job. This may be sooner if you work part-time. It will take longer – typically between four to six months, if you have an active job – but this will depend on exactly how active your job is. It’s significant to know how to get back to work after sick leave. You’ll need to do this gradually, if you have an active job. Discuss with your surgeon for advice.
People can go back to playing sport, most of them around six months after their operation. This varies from person to person though and will depend on the sport you play and how well you’re recovering. It’s vital to follow your surgeon’s instructions.
You can take over-the-counter painkillers such as paracetamol or anti-inflammatory medicines, such as ibuprofen, during your recovery. Make sure you read the patient information that comes with your medicine and if you have any questions, speak to your pharmacist for advice. You may also apply ice packs (or frozen peas wrapped in a towel) to your knee to help reduce pain and swelling. Don’t apply ice directly to your skin though, as it can damage it.
You won’t be able to drive until your surgeon gives you the go-ahead. Some surgeons may allow you drive if your left leg was the one operated on and you have a car with automatic gears.
You shouldn’t fly on a long-haul flight for at least six weeks after your surgery. Your surgeon may recommend waiting longer, so it’s important to always follow their advice.
Possible Side-effects of ACL Reconstruction
All procedures might come with some side-effects, but not that every person has every side-effect to the same extent as others. After ACL reconstruction you may have:
- Swelling and bruising
It’s likely to develop some pain after surgery and during the first six weeks after your operation knee may tend to swell. Please see our Recovery section for more information about managing pain and swelling.
Possible Complications of ACL reconstruction surgery
Complications are problems that occur at the time of or post-surgery. Excessive bleeding, developing a blood clot, usually in a vein in your leg (deep vein thrombosis) or having an unexpected reaction to the anaesthetic, can be the possible complications arising out of any operation.
The main complications of ACL reconstruction are listed below.
- Graft failure – The graft used to repair your ACL may tear. This has up to six percent probability in every hundred patients operated.
- A quite common complication can be experiencing numbness along the outside of your upper leg, near where the surgical cuts were made which can be temporary or permanent.
- Knee joint may remain unstable if the graft tears or stretches.
- You may have a risk of permanent stiffness in your knee, or less movement than you had before your injury (arthrofibrosis).
- The tendon/ligament your graft was taken from may weaken and tear.
- If the tendon in your knee was used as the graft you might have long-term knee pain, or pain when you kneel, which can be a problem.
- Infection is rare, happening in about one in two hundred people who have ACL reconstruction. But there is a slight possibility that you could get an infection. You’ll have IV antibiotics at the time of surgery to try and prevent it.
Pros and cons of ACL Reconstruction
This information is intended to help you recognize the advantages and disadvantages of ACL reconstruction. Think about how important each issue is to you. You and your doctor can work together to decide what’s best for you. Your decision will be based on your doctor’s expert opinion and your personal values and preferences.
- ACL reconstruction could help to stabilise your knee, relieve pain and reduce the risk of further knee injury.
- ACL reconstruction means you may be able to go back to playing sports, such as netball, football, rugby, basketball or skiing.
- ACL less invasive than some other forms of surgery as it is carried out in a keyhole procedure. This can result in less time spent in hospital, less pain and a faster recovery.
- You may need to take up to six months off work if you have an active job as It can take six months to fully recover from ACL reconstruction.
- For several months after your surgery you must stick to an exercise regime to help you recover.
- As with all surgical procedures, you might get side-effects and there’s a risk of complications. You could still get pain or stiffness in your knee after surgery.