ACL Reconstruction

What is ACL reconstruction?

ACL reconstruction surgery is a procedure to rebuild a torn anterior cruciate ligament (ACL) in your knee. The ACL is one of the major ligaments that stabilises the knee joint. Injuries to the ACL are common in sports like football, rugby, and skiing, where sudden twists, changes in direction, or impacts occur.

This surgery is typically recommended if you have a torn ACL causing instability and pain, particularly when trying to pivot or engage in physically demanding activities.

Why you might need ACL reconstruction surgery

A torn ACL can make your knee feel unstable, often described as a "giving way" sensation. Without a functioning ACL, activities like pivoting, turning, or sudden stops can become difficult. You may also experience pain, swelling, and limited movement.

ACL reconstruction surgery may be recommended if:

• Your knee feels unstable and affects daily activities.
• You are an athlete or physically active and want to return to sports.
• Non-surgical treatments, like physiotherapy, haven’t resolved your symptoms.
• Your injury involves damage to other parts of your knee, such as the meniscus.

If you are less active or can manage your symptoms with lifestyle adjustments, non-surgical options like physiotherapy may be suitable instead.

Preparing for ACL reconstruction surgery

Before surgery, you will meet with an orthopaedic surgeon for an assessment. This includes a physical examination and imaging, such as an MRI, to evaluate the damage.

You may also need physiotherapy before the procedure to strengthen your knee and restore as much function as possible. This prehabilitation can make recovery easier after surgery.

Your surgeon will discuss the use of a graft (tissue to replace the torn ligament), which can be taken from your own body (autograft) or from a donor (allograft). You might also need to stop taking certain medications, such as anti-inflammatories or blood thinners, before surgery to minimise bleeding risks.

What happens during ACL reconstruction surgery?

When you arrive at the hospital, you will meet a nurse, the anaesthetist and your surgeon. ACL reconstruction surgery is usually performed as a keyhole (arthroscopic) procedure under general anaesthesia. The procedure involves:

• Small incisions: The surgeon makes a few small cuts around your knee.
• Inserting the arthroscope: A thin camera (arthroscope) is inserted to view the damaged area.
• Reconstructing the ACL: A graft is used to replace your torn ligament. The graft is secured with screws or other devices, acting as a scaffold for new ligament growth.
• Closing the incisions: The small incisions are closed with stitches or surgical tape, and a dressing is applied.

The surgery typically takes 1-2 hours. Most patients can go home the same day, but some may need to stay overnight.

What are the potential risks and complications?

ACL reconstruction surgery is generally safe, but, like any surgery, it carries some risks. These include:

• Infection at the surgical site.
• Blood clots in the legs (deep vein thrombosis).
• Stiffness or loss of range of motion in the knee.
• Failure of the graft, which might require further surgery (rare).
• Temporary or permanent nerve damage around the knee.
• Persistent knee instability or pain despite surgery.

Your surgeon will discuss these risks with you and provide advice on how to minimise complications during recovery.

Recovery after ACL reconstruction surgery

Recovering from ACL reconstruction requires commitment to physiotherapy and rehabilitation exercises. Here’s what to expect:

• Initial recovery: You may feel sore and notice swelling around your knee. Pain relief will be provided. Keeping your leg elevated and applying ice can help reduce swelling.
• Walking aids: You will likely need crutches for 1-2 weeks to avoid putting weight on your knee. A knee brace may also be provided for additional support.
• Physiotherapy: This starts soon after surgery and is essential to regain strength, stability, and range of motion. Your physiotherapist will guide you through tailored exercises.

Most patients can return to light activities within 3-6 months, but it may take 9-12 months to resume high-impact sports, depending on your progress.

Long-term outcomes

ACL reconstruction surgery is highly effective in restoring stability and function to your knee, particularly if you want to return to sports or physically demanding activities.

Following a structured rehabilitation programme and your physiotherapist’s guidance is key to a successful recovery. While most people regain full function, there is a small risk of developing osteoarthritis in the knee later in life, especially if the injury also involved other knee structures.