Private anterior cruciate ligament (ACL) surgery in Greenwich
ACL reconstruction surgery is a major operation where the specialist surgeon replaces torn ligaments with new ones. But there are many factors to consider when deciding whether you need surgery or for it to be done urgently.
A consultant orthopaedic surgeon and knee specialist can provide an accurate diagnosis and help you decide whether ACL surgery is the best way forward. If you choose to go ahead, it’s up to you when you have it done.
When the knee becomes injured due to a strain or tear, you may experience rotational instability, which means that twisting movements cause your knee to become unstable and wobbly.
An ACL injury could mean a detached or stretched ligament or a partial or complete tear requiring reconstructive surgery.
Mr Abhijit Dey, Consultant in Trauma and Orthopaedic Surgery at the hospital, said:
“Commonly, in contact sports such as football and rugby, the studs get caught, and people twist the knee. They often describe a loud pop, and the knee becomes sore and swollen. They attend A&E, and because it’s not a fracture (break), it may not show up on X-rays, so people will come to see me for a diagnosis and treatment.”
Other common causes of an ACL injury are:
Rugby players often come to us with a medial collateral ligament injury on the inside of the knee because of how they are tackled from the side. Footballers tend to damage the anterior cruciate ligament, and girls and young women often sustain a kneecap dislocation injuring their medial patellofemoral ligament.
The term ‘ACL reconstruction’ means the ligament is replaced rather than repaired. Once the ligament is damaged, it often stretches, needing replacement rather than repair. Children have growth potential; therefore, a repair may be beneficial. However, repairs are unsuccessful in adults. That’s why the most common option is reconstruction.
You may decide not to undergo ACL surgery if you have a less active lifestyle. You may also choose against surgery if you’re self-employed and can’t afford to take time off work to recover. However, physiotherapy may still help your symptoms.
Mr Dey says: “I wouldn’t usually advise surgery as the first-line treatment for an ACL injury unless you are very symptomatic or a high-level athlete. For everyday activities, I would advise physiotherapy as the initial treatment.”
However, you may need ACL surgery if you play a sport regularly and don’t want to give it up. Mr Dey says if people decide to continue playing contact sports with an ACL reconstruction, 80% of them will return. Without an ACL reconstruction, this figure is 20%.
But he added: “The science behind the statistics may be slightly skewed. Patients who wish to return to sports may be more likely to go ahead with ACL reconstruction, while patients who don’t plan to return to sports probably wouldn’t have it done.”
At The Blackheath Hospital, patients from Blackheath, Greenwich and the Greater London area can see our knee specialists early on. They will encourage you to try non-operative methods such as physiotherapy first.
However, if you’re playing sports to a high level and are unable to perform the exercises, recovery will be slower, and the knee may still give way.
You may also be referred to physiotherapy in preparation for surgery. This is known as ‘prehab’. The stretches and exercises that your physio will want you to do are designed to ensure your knee has the full range of movement before the operation.
Mr Dey said: “The best way to plan ACL surgery is to talk to the patient about their injury. Patients will often describe a non-contact injury, hearing a loud ‘pop’, and that their knee became swollen almost immediately — the signs of an ACL rupture. The examination will give me an idea of how wobbly the knee is, while the inability to walk normally usually suggests that there’s something wrong.”
Your consultant will send you for an X-ray on the same day if they suspect that you have broken a bone. If a ligament has been injured, you’ll have a magnetic resonance imaging scan (MRI) within a few days.
An MRI helps your consultant confirm the diagnosis and whether something else is injured. For example, the shock absorbers in the knee (the meniscus) can also get torn. Sometimes, it is best to address these injuries in one go.
The risks and benefits of surgical and non-surgical treatment will be discussed at the consultation.
Traditionally, patients would have been kept in the hospital after ACL surgery for several days and the knee put in a brace. Today, the tendency is not to brace the knee, but that’s a conversation you’ll have had with your surgeon before the ACL operation. A brace may be suitable for your circumstances.
The average age for ACL surgery at The Blackheath Hospital is 18 to 30 years, although Mr Dey also performs ACL surgery in children if required.
The replacement ACL is usually created from the patient’s hamstring tendons — called a ‘hamstring graft’. The surgeon folds the graft until it is about 8cm in length and 8–10 mm in thickness, which is a perfect size to make a new ACL.
Each orthopaedic surgeon at Circle Health Group has a different approach to ACL surgery, and you should discuss which is more suited to you before surgery.
Other grafting techniques include:
ACL reconstruction surgery is usually performed under a general anaesthetic. On the morning of your surgery, your surgeon will see you, confirm the plan, and answer any additional concerns you may have.
The operation takes about an hour and a half, but may take longer if you have ACL and meniscus surgery.
Mr Dey uses an arthroscopic (keyhole camera) technique to drill small holes through the shinbone to the thighbone and thread the ligament through. It’s held at either end by screws (known as implants) or a specific device.
The keyhole cuts made during surgery take about two weeks to heal. You’re advised to keep the area dry and have showers instead of baths so that no water gets in. This helps to prevent infection.
After a couple of weeks, you’ll have an appointment with a nurse to make sure the site has healed, and your surgeon will see you at six weeks to see how well the physiotherapy is going. You’re typically discharged at that time.
Mr Dey says, “Most people do very well afterwards because their expectations of what they can and can’t do are discussed in the initial consultation. They understand why waiting is best before going back to activities such as skiing, with the usual return time to contact sports being 9-12 months. Patients reinjure their ACL reconstruction when they go back to sports too soon.”
The orthopaedic surgeons at The Blackheath Hospital meet for regular multidisciplinary meetings to discuss complex cases, such as revision (redo) surgery.
Most revisions are needed because you have reinjured your knee and usually involve donor grafts. We encourage patients to follow their post-operative rehabilitation regime to avoid further injury, but if revision ACL surgery is required, surgeons such as Mr Dey perform them.
The surgical team is skilled in performing complex surgeries and enjoys the challenge. The Blackheath hospital also has a high-dependency unit for patients with medical problems undergoing more complicated operations such as hip or knee replacement surgery.
The NHS website reports an 80% success rate with ACL surgery, with a re-rupture rate of 1 in 10.
A brace is less common nowadays but may be provided as a literal ‘belt and braces’ option. The reconstruction that Mr Dey performs doesn’t usually require a brace, but some surgeons prefer to use them, depending on their surgery, so you should do whatever your surgeon suggests.
You may not be given a brace for your knee after ACL reconstruction surgery. If you are, and your surgeon advises it, they will want you to wear it all the time, including at night.
Mr Dey said: “I use a technique whereby the screw is inserted into the bone and remains there, so you shouldn’t be able to feel it.”
To join the police, fire service or the armed forces, you must take a multi-stage fitness test (MSFT) called the shuttle run, repeated throughout your career.
Mr Dey said: “If you have an ACL injury and it’s not reconstructed, it may prevent you from joining even if you are initially symptom-free.”
According to the Ministry of Defence JSP 950 Medical Policy Leaflet, a complete ACL rupture means you cannot serve in the UK Armed Forces. If you have a partial tear, candidates are referred to medical entry staff in the single services for an opinion.
The recovery periods before returning to your sport are:
However, walking as much as you can from day one is encouraged to get the knee back to normal.
Mr Dey said: “We encourage you to bend your knee from zero to 90 degrees after surgery because that lubricates the joint and feels more natural. After any knee operation, you should get back on your feet as soon as possible to avoid stiffness and pain.”
You can choose from two types of ACL surgery at The Blackheath Hospital. It’s best to discuss with your consultant which one is most suitable. All prices include VAT.
All our self-pay quotations are fixed-price packages. They include one follow-up consultation post-surgery and up to six months’ post-operative care where clinically required by your consultant, provided it takes place at the hospital.
Allograft anterior cruciate ligament reconstruction (code W7440)
Autograft anterior cruciate ligament reconstruction (including arthroscopic and meniscectomy/meniscal surgery (code W7420)
You’re in safe hands, with many of our fellowship-trained surgeons teaching other surgeons at prestigious hospitals. They use the latest techniques in ACL surgery and some are experienced in complex cases, including revision (re-do) surgery — a super sub-speciality within ACL reconstruction surgery.
Our knee surgeons work closely with other healthcare professionals as part of a multidisciplinary ‘lower-limb team’, assuring you of first-class care.
The hospital regularly gets five-star reviews and high satisfaction rates.
We look forward to welcoming you.
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