ACL reconstruction surgery in Enfield

The knee is the largest joint in the body, and one of the most complex.

It is formed by the femur (thigh bone), the tibia (shin bone) and the patella (kneecap). It also contains cartilage that sits between the femur and the tibia. This cartilage allows the bones to glide over each other as the knee bends and straightens, and act as shock absorbers in the joint, helping to dissipate forces within the knee as it is used to avoid damage.

The knee is typically described as a hinge joint due to its ability to bend. However, the joint also provides about 30 degrees of rotational movement. As a weight-bearing joint, it plays a vital role in many everyday movements, including sitting, standing and walking.

A problem in the knee can have a significant impact on daily life and will often lead to limited mobility. Unfortunately, there are quite a few parts of the knee that can become damaged, including the anterior cruciate ligament — the ACL. Ligaments are bands of connective tissues that connect bones to one another. The knee has four main ligaments, each one of which attaches to the femur and tibia to provide strength and stability to the joint. These four ligaments are:

• Anterior cruciate ligament (ACL)
• Posterior cruciate ligament (PCL)
• Medial collateral ligament (MCL)
• Lateral collateral ligament (LCL)

While all four ligaments play an important role, the ACL is the most frequently damaged of the four and is the one we will be looking at in more detail on this page.

The ACL runs diagonally in the middle of the knee. It helps control the backward and forward movement of the lower leg and provides rotational stability to the knee.

The ACL can be partially or fully torn if the knee rotates while the foot remains planted on the ground (think of a footballer pivoting on one leg while kicking the ball with their other foot). This movement stretches the ligament and, if enough force is involved, can cause a partial or complete tear in it.

ACL injuries can be painful, are often debilitating and in some cases, will have a significant impact on quality of life.

Mr Joyti Saksena is a consultant orthopaedic surgeon who carries out ACL reconstruction surgery at The Cavell Hospital in Enfield. We asked him to describe how ACL damage occurs:

“ACL injury tends to happen when your knee is turned while your foot is planted firmly on the ground. We often see it in skiing or football, when your foot stays still because of studs on a football boot or the grips on a ski boot, and then the top half is effectively moving whilst your foot is staying static. And it is that momentum combined with an inward stress on the joint that causes injury.”

The most common causes of ACL tears are sports injuries. Data from The National Ligament Registry shows the three most common sports for ACL injury are:

• Football (soccer) – 47.8%
• Rugby – 12.3%
• Skiing – 12.1%

Any sport that involves a twisting of the leg while a foot is planted on the floor has the potential to cause ligament damage. This includes sports like netball, badminton, martial arts, basketball, hockey and baseball — anything where quick, sudden changes of direction are often necessary.

Although many people damage their ACL while playing sports, others will damage it through seemingly harmless or gentle movements or activities like walking downstairs or stepping off a kerb. ACL injuries are not exclusive to athletes and active people.

Although an ACL injury will often cause pain, some people won’t experience any pain at all. Other common symptoms to be aware of are:

• Hearing a popping sound in your knee when the injury occurred
• Swelling of the knee
• Leg giving way/instability in the knee
• Difficulty straightening the knee
• Reduced range of motion in the knee

Many people with an ACL injury will find they have to stop many of their normal activities because of their symptoms. These limitations can be quite hard to accept, particularly for people who are normally very active.

If you have any of these symptoms, particularly if they started immediately or soon after an injury to your knee, it is sensible to arrange a consultation with one of the knee specialists at The Cavell Hospital for assessment and advice. By getting an earlier diagnosis, you will be able to access any support or treatment needed much more quickly.

Symptoms from an ACL injury can sometimes be mistaken for other injuries, and vice versa. This makes an accurate diagnosis essential, to ensure you receive the most appropriate treatment for your specific condition

Mr Saksena highlights the importance of getting an early diagnosis:

“The most important thing with any type of knee injury is to make a diagnosis early. It may be that we find that your symptoms are not actually a result of damage to the ACL but instead are being caused by a meniscal injury or damage to one of the other ligaments, like the medial collateral ligament (MCL).

“Once we have a diagnosis we can plan treatment, but it’s important to know that ACL surgery will not be done immediately as we need to leave some time for things to settle down and for any swelling to subside. This normally means about 4–6 weeks, but during this time we can help manage any pain and arrange for you to have some prehab.”

Clinical history

Mr Saksena says that 90% of most medical diagnoses come from getting an accurate clinical history. By asking specific questions and listening extremely carefully to what a patient tells them, a consultant can begin to narrow down potential causes.

When you first meet your consultant at The Cavell Hospital, they will talk with you in detail about your symptoms and when they first started. They will want to find out whether you had experienced an obvious injury to your knee, and whether this occurred while playing sports, taking part in some exercise or while going about your normal activities.

Clinical examination

For many conditions, a physical examination can play an extremely important role in getting an accurate diagnosis. As Mr Saksena points out, many people with a recent ACL injury will often be (quite understandably) hesitant to let a doctor touch their knee and move it around in various ways.

Your consultant will carry out a clinical examination of your knee and leg as much as is possible, but this will often be a limited examination. If your ACL injury occurred some time ago, and any swelling and pain has subsided, a more thorough examination can be carried out.

The clinical examination, even if it is only a limited one, will often help reinforce what the consultant suspects from your clinical history.

Diagnostic investigation

While the clinical history and examination may be all that is needed to confirm a diagnosis, an MRI scan can often be helpful. This is easily arranged for you on-site at The Cavell Hospital. With our streamlined service, we can often arrange this for you at short notice, either on the same day or within 24 hours.

This is why all three aspects of the clinical investigation - your clinical history, the clinical examination and the results of an MRI scan - can be helpful in reaching a diagnosis and being able to plan treatment.

A damaged ACL will not normally heal naturally, so the extent of any damage will usually determine the most suitable treatment.

Minor ACL damage

If the tear is relatively minor, your knee may be able to retain its structural stability sufficiently with non-surgical treatment, avoiding the need for surgical repair.

Similarly, if you are not competing in sports or doing exercises that involve placing a lot of demand on the knee with twisting movements, non-surgical treatment may be able to give you the function and strength you need in the joint. 

Significant or extensive ACL damage

With more significant or extensive damage to the ACL, the knee may be left quite unstable.

This can become a problem when twisting or rotating the knee and may cause the knee to give way without warning. Even something as simple as stepping off a kerb or walking down some stairs can be problematic.

If your knee is regularly giving way due to an ACL tear, it may end up causing additional damage and even accelerate ‘wear and tear’ degenerative changes in the joint. For this reason, Mr Saksena normally advises people to consider ACL reconstruction if their knee is unstable during normal daily activities and movements.

Planning your treatment

If you are a professional athlete, a keen amateur or somebody who has an active lifestyle, you will probably be keen to get your knee back to normal (or as normal as possible) so that you can carry on participating at your chosen level of fitness.

Your consultant at The Cavell Hospital will talk with you about different treatment options. This will be based on the severity of your injury, the symptoms it is causing and your personal preference.

Different people will have different priorities, expectations and timelines for their recovery, and these all need to be factored in when planning treatment.

Smaller tears in the ACL can often be managed well with rest and rest physiotherapy.

Our physiotherapy team at The Cavell Hospital can help you:

• Reduce swelling in your knee
• Build up the muscles around the knee to restore strength and reduce the risk of your knee giving way
• Regain range of motion in your knee

A knee brace may be helpful, and this can be arranged and fitted for you where appropriate.

‘Prehab’, or prehabilitation, refers to beginning the rehabilitation process before surgery takes place.

If ACL reconstruction surgery is required, your consultant will usually arrange for you to have prehab at The Cavell in advance of the surgery.

Immediately following an ACL tear, your knee will often swell and have a limited range of motion. If surgery was carried out immediately, it would risk inflaming your symptoms and could cause problems moving the joint after the surgery.

Before surgery, your consultant will want to try to restore the range of motion in your knee, and strengthen the muscles around your knee. This approach is very similar to the physiotherapy details above, but instead of being a treatment by itself, prehab is focused on preparing your knee for surgery. The aim is to get your muscles stronger and more functional so that your recovery can be enhanced.

Mr Saksena explains why prehab is so helpful before ACL reconstruction:

“With prehab, we can build up the hamstrings (tendons at the back of the thigh) and quads (the muscles on the front of your thigh). Typically in ACL reconstruction, we use the hamstring tendons, so the more we can build up and strengthen the surrounding muscles, the sooner after surgery we can get the knee moving again and the better their rehab after surgery is.”

An ACL that is torn cannot be stitched back together, but it can be reconstructed using

a piece of tissue. This will usually be from the patient themselves but can be from a donor.

ACL reconstruction surgery restores stability in the knee and gives people the opportunity to return to their normal activities and exercise.

The surgery usually takes between 60 and 90 minutes, but the exact timings will vary.

For a comprehensive overview of ACL reconstruction surgery, please visit our main ACL reconstruction surgery page.

Following your surgery, it will take time to fully recover function in your knee. Mr Saksena breaks recovery from ACL surgery into three phases:

Phase one: the first two weeks

The ‘wound healing’ phase, usually lasts around two weeks from surgery. This is the time that stitches will be removed, and Mr Saksena sees his patients at this point to check everything is healing nicely.

Phase two: six weeks

By this stage, most people will have a full range of motion in their knee again. Again, Mr Saksena will see people at the 6-week mark to make sure their recovery is on track. If anything further needs to be done at this stage, such as manipulation of the joint, this can be arranged.

Phase three: 9–15 months

While recovery times vary for each individual, most people will have a full return to function and be able to get back to their normal activities anywhere between nine and 15 months after surgery.

Following your 6-week appointment, you will normally be discharged to physiotherapy, who will liaise with your consultant as needed.

If you have any concerns or queries at any stage during your recovery from ACL surgery, it is easy to arrange an appointment with your consultant at The Cavell Hospital to discuss things.

While many of the people we see at The Cavell Hospital live locally in Enfield, others travel from further afield to visit with us. This may be due to the reputation of the consultants working here, a recommendation from a friend or family member, or a referral from a GP or private insurance provider.

The Cavell Hospital offers a host of benefits for anybody who has suffered an ACL injury and is looking for tailored treatment.

Rapid access to a knee specialist

Appointments are available with an experienced knee specialist six days a week (Monday – Saturday).

Some consultants run evening clinics which are particularly helpful for people who would prefer not to have to take time off work for a medical appointment.

Earlier diagnosis

In some healthcare settings, there can often be quite a long delay between appointments and diagnostic investigations, extending the time it takes to plan appropriate treatment. This is not the case at The Cavell Hospital!

With an earlier diagnosis through our streamlined care pathway, treatment can be planned much more effectively. For example, if you have damaged both a meniscus and your ACL, your surgeon may suggest a two-stage procedure — repair the meniscus first and then the ACL at a later date.

Treatment to fit your diary

Timings for surgery can be scheduled to fit around your lifestyle.

For example, if it is near the beginning of summer, you may prefer not to have ACL surgery as it would mean you would be laid up over the summer and limited with what you can do while you recover. In this case, you might prefer to schedule your surgery once the summer is over. Private care at The Cavell Hospital provides you with this flexibility.

Fast access to imaging

The diagnostic imaging department at The Cavell Hospital is open seven days a week (Mon - Thursday 8am - 9pm, Friday 8am - 8pm, Saturday and Sunday 8am - 4pm).

This means that an MRI scan can be quickly arranged for you if needed to help with diagnosis.

Cost of ACL surgery at The Cavell Hospital

Details of our fixed-price packages can be seen on this page.

You will always receive written confirmation of the fee for your ACL reconstruction surgery after your initial consultation and once any additional investigations (like MRI) have been carried out.

It is easy to book a private consultation at The Cavell Hospital with a knee specialist of your choice. You can either book online or phone us on 020 8366 2122.

With consultations available at our private hospital in Enfield six days a week (Monday - Saturday), we can help you access the expert-led care you need without delay.