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ACL reconstruction surgery

Private anterior cruciate ligament (ACL) surgery in East London

Doctor pointing to part of a knee joint model
The anterior cruciate ligament (ACL) is an important ligament that secures your knee’s stability and movement. If it is partially torn or fully ruptured, most commonly from a sporting injury, you might require reconstructive surgery to replace your ACL.

ACL injuries are amongst the most common knee injuries. They typically occur during sports that require sudden stopping and starting and pivoting movements.

Not everyone who has injured their ACL needs surgery, but if you would like to return to the same level of physical activity or your knee is extremely unstable and has sustained further injury, ACL surgery is typically recommended.

This article will explore who might need ACL surgery, how it is performed, considerations for surgery success and recovery times at The London Independent Hospital.

Please note that some of the details on this page are specific to The London Independent Hospital in Stepney Green, East London. If you live somewhere else in the UK and would like to know more about ACL surgery, you can find your local Circle Health Group hospital on this page.

The knee is one of the most complex and largest joints in the body. It is made up of three bones: the femur (thigh bone), the tibia (shin bone) and the patella (kneecap), as well as cartilage and ligaments.

Ligaments are strong bands of tissue that connect bones to bones. Four major ligaments of the knee support the knee’s stability: two cruciate ligaments and two collateral ligaments.

The collateral ligaments on the sides of the knee control the sideways motion of your knee. The cruciate ligaments are located inside the knee and control your knee’s back and forth motion. The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) cross each other to form an ‘x’ inside your knee joint.

Your ACL runs diagonally in the middle of the knee to connect the upper part of the tibia (shin bone) with the lower part of the femur (thigh bone). Along with the PCL, the ACL provides stability to the knee joint.

Approximately half of all ACL injuries occur in combination with damage to the meniscus. The menisci are two C-shaped pieces of cartilage that cushion the femur and tibia bones of the knee during weight-bearing activities.

If you have a torn or ruptured ACL, you might be wondering if surgery is the only option. You should discuss several considerations with your consultant to decide if surgery is right for you. Treatment options must be individualised to the patient depending on various factors.

According to Mr Tarun Taneja, Consultant Orthopaedic & Knee Specialist Surgeon at the London Independent Hospital, “Each patient’s treatment has to be individualised depending on factors like their age, activity levels, sporting activities and what their expectations are in terms of their activity levels after their recovery.”

He continues, “It’s also dictated to an extent by their associated injuries. If somebody has a significant meniscal injury in addition to an ACL tear and is a young, active person, that almost pushes us more towards the surgical option.”

Your consultant is likely to recommend ACL reconstructive surgery if you are an active adult and any of the following applies to you:

  • You play sports with a lot of jumping, pivoting or cutting movements
  • You have an active job that involves manual labour
  • You have additional damage to your knee that needs to be repaired (such as other ligament damage or a meniscus tear)
  • Your knee is very unstable and feels as if it will give way
  • You have tried conservative therapy, but it has not met your expectations regarding your desired activity level

Surgery is usually the best choice for young, active patients to stabilise their knee and ensure their return to sports and other activities.

Older and more sedentary individuals might decide against ACL reconstructive surgery in favour of conservative therapy. This includes physiotherapy, modifying your activities and using knee braces. You should be prepared to give up high-risk sports that involve cutting and pivoting for activities such as swimming, cycling or yoga.

After your consultant has discussed your personalised treatment plan for your ACL reconstruction with you, you will need to wait a few weeks for the swelling to go down and to ensure your knee's full range of movement.

ACL surgery prehab

Before surgery, it is a good idea to do physiotherapy to strengthen your muscles, particularly your quadriceps.

Rehabilitation before surgery — ‘Prehab’, or prehabilitation — is an integral part of the process.

Ensuring that your knee has its full range of motion and that your muscles are as fit and healthy as they can be before your surgery helps you recover faster after your ACL surgery.

Booking your ACL surgery

When your consultant says you are ready for surgery, you can book your appointment for your operation. One benefit of private care at The London Independent Hospital is the ability to book your surgery at a time that suits you.

Your consultant will let you know what specific preparations you need to do for the surgery. This could include instructions and information about:

  • What tests you might need to take
  • Fasting instructions
  • If you need to stop taking certain medications
  • The benefits of quitting smoking before orthopaedic surgery

ACL reconstructive surgery is an outpatient surgery, which means that you can go home the same day — although you will need to arrange a lift home from the hospital.

The surgery takes between 1–2 hours, and you will be under general anaesthesia, so you will be unconscious, and you will not feel any pain during the procedure.

ACL surgery can be done in various ways, but the most effective method is reconstructing your ACL ligament with a piece of your tendon, a band of tissue that connects your muscle to a bone. This tendon is called a graft and functions as the new ACL.

What types of grafts are used?

A graft taken from your own body is called an autograft. A graft taken from a donor (someone who has given permission for their organs to be donated after their death) is called an allograft.

Autografts can be sourced from various places:

  • Hamstring – the back of the thing
  • Quadricep – front of the thigh
  • Patellar tendon – the tendon that holds the knee cap (the patella) in place

Your surgeon will discuss details of the surgery, graft options and post-surgery rehabilitation.

How is ACL surgery performed?

The procedure is performed using a technique called knee arthroscopy, which is more commonly known as keyhole surgery.

This means that your orthopaedic surgeon will make small cuts in your knee and pass an arthroscope (a thin, metal tube with a light and camera at the end) into your joint. Your surgeon will use the attached monitor to clearly see inside your joint and determine the extent of your injury and if any other repair work to other ligaments, such as repairing the meniscus, needs to be done.

After harvesting the graft, the surgeon will drill two bone tunnels — one in your tibia and another in your femur, and thread the graft through. Your surgeon will then fix the tendon into place with screws and/or metal buttons, which will remain in your knee permanently.

Your surgeon will also repair any other structures of the knee, such as ligaments or meniscus tears, before closing your incisions with stitches. You will be given pain relief and a local anaesthetic to alleviate pain upon waking.

Once conscious, you will start physio the same day before being discharged to go home.

Your consultant will give you specific instructions on caring for your knee after the surgery. These should include getting plenty of rest, elevating your knee, taking pain relief medication as prescribed and using ice.

After six weeks, you will have a post-operative appointment with your consultant to check that your wound is healing properly and assess your full range of movement and muscle strength.

You’ll have additional check-ups with your consultant following the initial appointment.

How long after surgery will it take to get back to normal activities?

Your recovery timeline after surgery will depend on your individual situation. The healing process takes about nine months to get back to your pre-injury activities.

After your surgery, physiotherapy will be essential to help you reach your individual rehabilitation goals.

With guidance and personalised exercises from your physiotherapist, you might expect to have a recovery that roughly follows the following timeline:

  • 0–2 weeks: you will recover at home and slowly work on bearing weight on your leg
  • 2–6 weeks: you will focus on being able to move normally and walk without crutches. Once you can bear weight on your leg, you should be able to drive again (at approximately three weeks)
  • 6–12 weeks: your full range of movement should be restored
  • 12 weeks–6 months: after twelve weeks, you should be able to return to exercises such as walking, cycling and swimming, although you should avoid contact sports
  • 9–12 months: you should be able to return to contact sports after being cleared by your consultant

ACL reconstructive surgery is major surgery with a lengthy recovery process. But with the right specialist knee surgeon, you can expect good outcomes for returning to your pre-injury activity levels.

“ACL surgery, when properly performed by an experienced knee surgeon, is a very successful surgery,” says Mr Taneja. “Most people will be able to get back to their pre-injury levels of activity. If you’re treated by a knee surgeon who has experience in dealing with both ACL injuries and meniscal repairs, most people will be happy with the outcome.”

Before deciding to have ACL surgery, you should consider whether you can commit to the lengthy healing process. The importance of post-operative rehabilitation cannot be overstressed, according to Mr Taneja:

“The post-operative rehab after ACL surgery is crucial. There are about nine months of physiotherapy, and that’s almost as important as the surgery itself. So I always stress to my patients that if you cannot commit to the post-operative rehab, then you don’t need to have the surgery now. We can schedule it for a time when you think you’d be able to devote time to these  nine months of rehab.”

In addition to physiotherapy, there are several things that patients can do to ensure their best outcome of success after their ACL surgery:

  • Get realistic expectations from your consultant before the surgery
  • Have a positive attitude about the process because it is long and can involve setbacks
  • Commit to following your rehabilitation plan
  • Make sure you choose a surgeon who will be available to you after the surgery
  • Choose a hospital where the surgeons and physiotherapists work together

It’s important to follow your consultant’s instructions for returning to sport. ACL ligaments take time to grow, and if you return to sport too soon against your consultant’s recommendations, you can risk re-rupturing your graft.

ACL injuries are very common, but the decision to get ACL reconstruction surgery should not be taken lightly. It’s major surgery with a lengthy recovery period.

With a skilled orthopaedic surgeon and your dedication to post-operative rehabilitation, you can expect good results from your ACL reconstruction. However, it’s essential that you choose the right hospital and the right surgeon to ensure your best chance of success.

“You need to go to a surgeon who is available for you at every step of the way in those nine months. You want to choose a surgeon you can depend on throughout that year and beyond if you face any problems even after a year. You also need a surgeon who will be able to liaise with physiotherapists,” said Mr Taneja.

“I think it is important for patients to choose a surgeon who is working in multidisciplinary teams with nurses and physiotherapists like we do at The London Independent Hospital because those teams can provide a higher quality of care.”

The London Independent Hospital in East London offers private ACL injury treatment and ACL reconstructive surgery performed by specialist knee orthopaedic surgeons. As part of the Circle Health Group, it also provides access to the latest technology and equipment.

The benefits of choosing The London Independent Hospital

When you choose The London Independent Hospital for your ACL surgery, you will be assured of the following benefits:

  • Consultations and surgery can be booked around your schedule (no waiting lists)
  • Access to in-house physio teams and a fully equipped rehabilitation gym
  • Multidisciplinary teams that work together for your care
  • A personalised treatment plan tailored to you
  • Your surgery will be performed by your consultant, an expert orthopaedic knee specialist
  • Transparent, fixed-price treatment packages

Cost of ACL surgery in London

Our transparent fixed-price packages for ACL reconstruction are given to you in writing, so there are no hidden costs or surprises. We also offer flexible payment options for our self-pay patients.

The London Independent Hospital can be found at 1 Beaumont Square, Stepney Green, London, E1 4NL. It is accessible by bus, tube (Stepney Green) and a car park with 30 spaces.

Book an appointment online today or call us at 020 7780 2400.

Specialists offering ACL reconstruction surgery

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Mr Kostas Tsitskaris

Trauma and Orthopaedic Surgeon (Hip and Knee)

MD, MSc, FRCS(Tr&Orth)

The London Independent Hospital

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Mr Chatenya Chauhan

Consultant Surgeon. Trauma & Orthopaedic

MbChB, FRCSEd, FRCSEd (Orth & Trauma)

The London Independent Hospital 1 more Southend Private Hospital

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Mr Amer Khan

Consultant Orthopaedic Surgeon

BSc(Hons) MB BS FRCSEd FRCS(Tr&Orth)

The London Independent Hospital

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Mr Ziali Sivardeen

Consultant Orthopaedic Surgeon

BMEDSCI, BMBS, AFRCS, FRCS (TR AND ORTH)

The London Independent Hospital

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Mr Steven Millington

Consultant Orthopaedic Surgeon

BMed Sci BMBS FRCS (Tr&Orth) PhD

The London Independent Hospital

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Mr Deepu Sethi

Consultant Orthopaedic & Knee Surgeon

MBBS MRCS FRCS (T&O)

The London Independent Hospital

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