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ACL reconstruction surgery

ACL reconstruction surgery is a type of knee surgery that involves repairing or reconstructing  your anterior cruciate ligament (one of four ligaments found in your knee). We look at the symptoms of an ACL injury and explore how physiotherapy and ACL reconstruction surgery can help restore mobility in your knee.

What is ACL reconstruction surgery?

ACL reconstruction surgery is a type of knee surgery that involves repairing or reconstructing the anterior cruciate ligament (ACL).

The anterior cruciate ligament is one of four ligaments in your knee that is essential in keeping your knee stable. If you've torn or ruptured your ACL, it can be reconstructed by replacing the ligament with a graft. This will stop the knee from giving way when making twisting or turning movements.

How do ACL injuries happen?

ACL injuries occur when the knee joint is twisted or overextended. Your ACL can be injured if you change direction quickly, land from a jump incorrectly, stop suddenly or have a direct collision. This type of injury is relatively common in sport. The ligament tear usually happens when playing sports such as football, rugby, tennis or skiing. You can injure other parts of your knee at the same time, for example, tearing cartilage or damaging the joint surface.

What are the symptoms of an ACL injury?

If you've torn your anterior cruciate ligament, your knee will feel very unstable and it can become incredibly difficult to play sports.

If you experience any of the following symptoms, you may have injured your ACL:

  • Hearing a loud "pop" in the knee and experiencing severe pain afterwards
  • Pain and swelling
  • Difficulty walking
  • Loss of full range of movement
  • Difficulty straightening the knee

How is an ACL injury diagnosed?

Your consultant will ask how the injury happened, what symptoms you have and to explain the pain you are feeling. They will then physically examine your injured knee to check for swelling and tenderness, and also compare it with your healthy knee. Your consultant may also use an X-ray or an MRI scan to confirm an ACL injury diagnosis.

What are the benefits of ACL reconstruction surgery?

ACL damage probably won't affect your day-to-day life. However, if your injury is affecting your ability to play sport, then surgery may be beneficial. The main benefits of surgery are that the knee should no longer give way, function can be restored and your knee will feel stable again. After successful surgery, you should also be able to eventually return to playing sport.

What does the operation involve?

If you decide to have ACL reconstruction surgery, you will either have a general anaesthetic, which means you'll be unconscious throughout the operation, or a spinal anaesthetic that will numb your lower body. However, your anaesthetist can recommend which type is best for you.

Your surgeon will make one or more cuts on the front and sides of your knee. Some surgeons perform the operation by arthroscopy (keyhole surgery) where a camera is used to see inside the knee. The ACL will be replaced with a piece of suitable tissue (a graft) from elsewhere in the body. The top and bottom ends of the replacement ligament are fixed with special screws or anchors into ‘tunnels' drilled in the bone.

ACL reconstruction surgery typically takes between an hour and an hour and a half, and you will usually have to spend the night in hospital.

Are there any alternatives to surgery?

Physiotherapy can be an effective alternative to surgery. Your physiotherapist can teach you exercises that can strengthen and improve the coordination of the muscles around your knee. These exercises may help prevent the knee from giving way during everyday activities. Wearing a knee brace can sometimes help if you are playing sports.

When deciding whether or not to have surgery, the level of damage to your knee and how it affects your life are important factors. If you have an active lifestyle, a delay in surgery could result in further damage to your knee.

What complications can happen after surgery?

Although rare and uncommon, any surgery has certain risks. However, any potential complications will be discussed prior to your surgery.

Risks of surgery can include:

  • Pain
  • Bleeding
  • Surgical wound infection
  • Unsightly scarring
  • Blood clots
  • Difficulty passing urine

Complications of knee surgery can include

  • Break of the kneecap
  • Damage to nerves around the knee
  • Infection in the knee joint
  • Discomfort in the front of the knee
  • Loss of knee movement
  • Recurrent giving way of the knee
  • Severe pain and stiffness
  • Loss of use of the knee (Complex Regional Pain Syndrome)

How long does it take to recover from ACL surgery?

Depending on your overall health, injury and specific operation, you might be able to go home the same day as your surgery, or you may need to stay in hospital for one night.

Your consultant may recommend that you wear a knee brace for the first few weeks to help ease pain and swelling. Once the knee has settled down, you'll begin physiotherapy treatment which could last as long as six months. These exercises will help improve your mobility, strengthen your muscles and help you to walk properly again.

There is no set timeline for rehab and recovery as everybody recovers differently after ACL reconstruction. Regular exercises should help you to return to daily life as soon as possible and typically after two to three weeks, you should feel able to walk without the use of crutches or a walking aid. However, getting back to your normal activities may range from six weeks to six months.

It's important to give your knee adequate time to heal. Make sure to rest properly, complete your exercises and be patient. If you have any concerns or questions during your recovery, it's best to ask your consultant for advice.