Anterior Cruciate Ligament (ACL)
ACL Knee Surgery
ACL Knee Surgery
Once a diagnosed with an anterior cruciate ligament (ACL) knee condition, your Knee Specialist will then discuss with you the best treatment. Not all treatment of an ACL injury includes a surgical procedure. However, if surgery, or as it is sometimes called, reconstruction is advised, then ‘keyhole’ surgery or an arthroscopic operation will be necessary.
The main purpose of ACL surgery is to replace the damaged ligaments with other strong tendons from areas around the knee. The surgeon will decide where to graft the tendons from, which will be either from the hamstring tendon or the patella tendon. Both types of graft are considered equally as good, but the choice is usually dependent upon the surgeon’s preference, which will be based upon the patient’s current state of health or other circumstances surrounding the operation, which may affect the decision. Which ever graft is carried out, post-operative rehabilitation is the same.
How is ACL Surgery performed?
ACL surgery is performed under a general or spinal anesthesia and usually takes between 1 and 1½ hours. The surgeon will harvest the chosen graft through small incisions, which is then prepared into a new ligament. The surgeon will then remove the damaged ligament to allow enough space for the new graft to be put into place.
The surgeon will make tunnels in the shin (tibia) and thighbone (femur) at the anatomical site of the attachment points of the old ligament. If the patella tendon graft has been used, this is held in place by two bio-absorbable screws, which are slowly incorporated into the body. The hamstring graft would be held in place within the tunnels using a small metal bar (endobutton) on the femur and an absorbable screw at the shin bone end. Neither of these fixation devices usually needs to be removed.
Whilst the surgeon is performing the ACL surgery, he will also check to see if there has been any other damage, such as a mensical tear or articular cartilage damage. If there are signs of damage, then the surgeon will most likely repair the damage during this procedures so as to avoid a further procedure later.
Recovery from ACL Surgery
As soon as you have had your ACL surgery, you will be prescribed analgesics or painkillers for several days following surgery. You may also be prescribed anti-inflammatory tablets for a short period, if the analgesics alone are not able to control the pain, but these are stopped as soon as the knee becomes more comfortable. Discharge from hospital is usually 48-72 hours after surgery.
Physiotherapy is a very important part of recovery from ACL surgery, and so following surgery you will be immediately seen by a physiotherapist and provided with a programme of simple exercises, initially to help control the pain and swelling. Patients are usually able to stand and walk gently with crutches within 24 hours of surgery and crutches can usually be discharged within 2-4 days following surgery. A supporting knee brace is usually fitted as this keeps the knee locked in a straight position, especially at night and is worn for between 4-6 weeks.
With physiotherapy you should be able to regain a full range of knee motion within 6 weeks of surgery. As you progress, the physiotherapy programme will be directed towards balance, muscle reaction and reflexes and proprioception. Providing you continue with your physiotherapy and follow the advice of the therapist, then patients can expect to be driving, static cycling, gentle swimming and gentle low weight gym exercises after 6 weeks and gently increase the level of exercise after 12 weeks. More vigorous exercise such as squash, tennis or field sports can expect to be commenced around 6 months following surgery.
Surgery Consultation Process
As with all surgical procedures, Mr Guido Geutjens, Specialist Knee Surgeon, takes all of his patients through a thorough examination and diagnosis process before any surgical procedure is performed. Mr Geutjens will always ensure that a surgical approach is the most appropriate option and will fully explain the benefits and risks involved with any surgical procedure before proceeding.
When would I need ACL knee surgery?
Not all ACL injuries require surgery, but if you want to return to full sporting activities or if you have severe instability symptoms in day to day life, your surgeon will recommend a surgical procedure in the form of a reconstruction.
How quickly will I recover from an ACL injury?
As a general rule, you can expect to be discharged from hospital within 24 hours following surgery. You will probably need a crutches for up to 3 weeks. Occasionally, the knee will need to be braced for a period of six to eight weeks. With physiotherapy, you can expect to be participating in light exercise within about 12 weeks and fully recovered by 6 to 12 months.