ACL reconstruction

The anterior cruciate ligament(ACL) is one of strong ligaments of the knee that helps to stabilise the knee and prevent it from giving way. It is one of the structures that is most commonly injured in a non-contact pivoting injury often accompanied by an audible “pop”. The knee swells within a few minutes of the injury and most commonly people cannot walk on the knee in the immediate aftermath. As the knee begins to recover the swelling may settle but patients begin to experience feelings of instability in the knee with episodes of giving way, particularly when trying to quickly change direction.

How is ACL reconstruction performed ?

This surgery is performed as a keyhole operation involving a number of small incisions around the knee and avoiding the need to open the knee joint.

The operation starts with an arthroscopy that allows the surgeon to assess the knee and prepare the knee to receive the new ACL graft.  The old scar tissue is removed and tunnels drilled in the femur (thigh-bone) and tibia (shin bone) to accept the new graft.  The graft is then taken either from the patella tendon (kneecap) or the hamstring tendons(muscles in the back of the thigh) and prepared to be inserted in the knee.  The graft is then carefully thread through the new tunnels in the knee and secured in place.

What type of graft is best for me?

There is no “perfect graft” as both grafts rely on taking normal healthy tissue from an uninjured part of the body.Your surgeon will be able to advise on why they think a certain graft may have benefits in each case.

What’s the rehabilitation period?

Rehabilitation following ACL reconstruction requires a long period of supervised and intensive physiotherapy as an outpatient. As a rough guide you will be fully mobile with crutches on the day of operation and focus on swelling control, range of movement and static muscle exercises in the first few weeks. From 2 weeks onwards you can start using a static cycle to gently condition and build the muscles around the knee. At 6 weeks resistance training on static bikes and outdoor cycles commences and providing you are making good progress, gentle jogging can be introduced. We aim for a return to non-contact sports between 6 and 9 months and contact sports at 9 months to a year, when the strength of the affected knee is within 10% of that of the healthy knee.