ACL reconstruction surgery in Greenwich

The anterior cruciate ligament (ACL) is like a rope holding the thighbone and shinbone together, keeping the knee stable during twisting movements.

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.

A sporting injury is the leading cause of patients with an anterior cruciate ligament injury at The Blackheath Hospital. It commonly occurs in rugby, football, netball and skiing, where you use twisting movements.

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:

• Changing direction quickly
• Jumping and landing with a twist
• Colliding during a tackle
• Stopping suddenly

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.

Not everyone needs an ACL reconstruction. ACL surgery often depends on how quickly the injury is diagnosed. If you see a consultant orthopaedic surgeon early enough, they might send you to physiotherapy depending on the damage and other factors.

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.

The Blackheath Hospital has specialist ACL physiotherapists for sports injuries. They can help you build up the muscles to compensate for the twisting movement so you can continue to work and do activities.

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.

On your first visit to The Blackheath Hospital, your consultant orthopaedic surgeon will ask questions such as how you injured the knee and where it hurts before undertaking a physical examination.

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.”

Diagnostic testing

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.

The expert team of surgeons, anaesthetists, and theatre staff at The Blackheath Hospital are so experienced that most ACL surgery is performed as a day-case procedure.

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.

Using grafts for ACL reconstruction

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:

• The surgeon uses the patient’s quadriceps tendon (the tendon above the kneecap)
• A patella tendon reconstruction uses the tendon in the front of your knee, some bone from the kneecap and the shinbone
• A donor graft may be used, particularly for revision (redo) ACL surgery
• An artificial graft may be used

What to expect in ACL surgery

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.

Once you have had ACL surgery, you will return to the ward and your private room. You’ll get up and walk with excellent rehabilitation from the physiotherapy team immediately on the same day. They will aim to get you home that day as well.

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.”

ACL revision surgery

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.

Below are some frequently asked questions about hip replacement surgery at The Blackheath Hospital, London.

How successful is ACL surgery?

The NHS website reports an 80% success rate with ACL surgery, with a re-rupture rate of 1 in 10.

Do I need a brace after ACL surgery?

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.

Should I sleep with a brace on?

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.

Can you feel the screws after ACL surgery?

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.”

Can you join the police or the navy after ACL surgery?

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 physiotherapy team will look after you for six weeks after the operation. You must be prepared to follow your recovery plan and do the exercises.

The recovery periods before returning to your sport are:

• Indoor exercise bike – six weeks
• Running and cycling – three months
• Contact sports like rugby – 9 to 12 months

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)

• Hospital procedure fee – £6,102
• Consultant procedure fee – £1,800
• Anaesthetist fee – £750
• Total procedure cost – £8,652

Autograft anterior cruciate ligament reconstruction (including arthroscopic and meniscectomy/meniscal surgery (code W7420)

• Hospital procedure fee – £5,380
• Consultant procedure fee – £1,286
• Anaesthetist fee – £58
• Total procedure cost – £7,250

The Blackheath Hospital is fully equipped for anterior cruciate ligament (ACL) surgery, performed by experienced orthopaedic surgeons specialising in knee injuries.

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.

If you think you may need ACL reconstruction surgery, you can book a private consultation online today or call us on 0208 3187722 to speak with one of our friendly team members at The Blackheath Hospital.

We look forward to welcoming you.