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ACL Surgeries

The ACL is a band of stringy tissue that settles your knee. You can tear or sprain your ACL – it's a champion among the most surely understood knee wounds. Most by far of them (around seven out of ten ACL wounds) happen when playing sports. Harm normally happens when you back off quickly while turning or dodging meanwhile. A couple of diversions that are particularly disposed to causing ACL harm are b-ball, netball, rugby, football and skiing.

Who needs ACL reconstruction?

If you’ve torn your ACL, your doctor is likely to suggest a reconstruction if your knee is unstable (gives way) and you:

  • Previously played a lot of sport and want to get back to it
  • Have an active job, which involves heavy lifting or where it would be unsafe to have an unstable knee, for example roofers, or people in the military or police force
  • Have other damage to your knee

Preparation for ACL reconstruction

Your surgeon may delay the operation to allow any swelling to go down as much as possible and any stiffness in your knee to be resolved. It’s best if you have a pain-free, full range of movement in your knee by the time you have surgery. Otherwise, the result may not be as good as it could be. Your operation is likely to be at least three weeks after your injury, but this varies from person to person. Your surgeon may ask you to have physiotherapy during this time. As well as making sure you can move your knee as fully as possible, exercises will help:

  • To reduce swelling
  • To strengthen surrounding muscles
  • Your recovery after surgery

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you’ll be asked to stop. Smoking increases your risk of getting a chest and wound infection, which can slow your recovery. You may also be asked to stop taking the contraceptive pill, as it can increase your risk of blood clots. Cuts and scratches below the knee can increase your risk of getting an infection after surgery. So your surgery may be delayed until they’ve healed. This is why your surgeon may ask you to stop shaving your legs up to six weeks before your operation.

You may have your operation under a general anaesthetic or an epidural (spinal anaesthetic). If you're having a general anaesthetic, you’ll usually be asked to follow fasting instructions. This involves not eating or drinking for a set amount of time before your surgery. It’s important to follow your surgeon’s advice. You’ll usually be asked to stop eating six hours before your operation, but can drink water up to two hours before.

Your surgeon and anaesthetist will talk to you about your procedure beforehand. They’ll answer any questions you have and tell you what to expect. Do ask any questions you’d like answered so you understand what will happen. It may help to have a list of questions ready to ask. Once you’re happy that all your questions have been answered, you sign a consent form, giving your permission for the procedure to go ahead.

What happens during an ACL reconstruction?

  • ACL reconstruction is carried out with a general anaesthetic or a spinal anaesthetic. If you have a general anaesthetic, this means you’ll be asleep during the operation. These days, this type of surgery is often done as a day case, so you don’t go to hospital until the day of the surgery and go home the same day.
  • Before the operation, you’ll meet your surgeon to discuss your care. It may differ from what’s described here as it will be designed to meet your individual needs. After you have had the anaesthetic, your surgeon will examine your knee to check how badly your ligament is torn and if any other tendons or ligaments have been damaged. Although they’ll have examined your knee before, it’s easier to do a very thorough examination when you are completely relaxed.
  • ACL reconstruction is keyhole surgery, meaning it’s done through several small cuts. Your surgeon will make these cuts in the skin over your knee. They’ll use an arthroscope – a thin, flexible tube with a light and camera on the end of it to see inside your knee. This is known as knee arthroscopy. ACL reconstruction involves replacing your torn ligament with a graft. In ACL, a graft is usually a piece of tendon that is put in place of the injured ACL. It acts as scaffolding for a new ligament to grow along. Your surgeon will first, remove the piece of tendon to be used as the graft.
  • Sometimes surgeons use a graft from a donor. This is called an allograft and will be collected before your surgery. You’re most likely to have a donor graft if you’re having further surgery to an ACL repair. You can find out more about grafts used in ACL reconstruction in our FAQs below.
  • Your surgeon will then drill a tunnel through your upper shin bone and lower thigh bone. This means the graft can be put in almost the same place as your damaged ligament. They’ll put the graft into the tunnel, attach it to your bones and fix it in place, usually with screws or staples. These are normally left inside your knee permanently. Before finishing the operation, your surgeon will make sure there is enough tension on the graft and that you have full range of movement in your knee. Then they’ll close the cuts with stitches or adhesive strips. Your operation will usually last between one and three hours.

Recovering from an ACL reconstruction:

It usually takes about six months to make a full recovery from ACL reconstruction. But to start with, it’s important not to do too much. Your leg should be up when you’re not moving around or doing your exercises. Avoid too much standing or walking. If your knee starts to swell, you’ve overdone it. It takes about two weeks after ACL surgery to be able to walk without crutches, fully straighten your leg and bend it to 90 degrees. If you have a desk-based job, you may be able to go back to work four to six weeks after your operation. This may be sooner if you work part-time. If you have an active job it will take longer – typically between four to six months – but this will depend on exactly how active your job is. It’s important to know how to get back to work after sick leave. If you have an active job, you’ll need to do this gradually. Speak to your surgeon for advice. Most people are able to go back to playing sport around six months after their operation. This varies from person to person though and will depend on the sport you play and how well you’re recovering. It’s important to follow your surgeon’s advice. During your recovery, you can take over-the-counter painkillers such as paracetamol or anti-inflammatory medicines, such as ibuprofen. Make sure you read the patient information that comes with your medicine and if you have any questions, speak to your pharmacist for advice. You can also apply ice packs (or frozen peas wrapped in a towel) to your knee to help reduce pain and swelling. Don't apply ice directly to your skin though, as it can damage it. You won’t be able to drive until your surgeon gives you the go-ahead. Some surgeons will let you drive if your left leg was the one operated on and you have a car with automatic gears. If you're in any doubt about driving, contact your motor insurer for their recommendations, and always follow your surgeon's advice. You shouldn’t fly on a long-haul flight for at least six weeks after your surgery. Your surgeon may recommend waiting longer, so it’s important to always follow their advice.

Complications of ACL reconstruction

Complications are problems that occur during or after your operation. The possible complications of any operation include excessive bleeding, developing a blood clot, usually in a vein in your leg (deep vein thrombosis), or having an unexpected reaction to the anaesthetic.

The main complications of ACL reconstruction are listed below:

  • The graft used to repair your ACL may tear (graft failure). This happens in up to six in every hundred patients.
  • You might experience numbness along the outside of your upper leg, near where the surgical cuts were made. This is quite common and can be temporary or permanent.
  • Your knee joint may remain unstable if the graft tears or stretches.
  • There’s a risk of permanent stiffness in your knee, or less movement than you had before your injury (arthrofibrosis).
  • The tendon your graft was taken from may weaken and tear.
  • You might have long-term knee pain, or pain when you kneel down. This can be a problem if the tendon in your knee was used as the graft.
  • It’s possible that you could get an infection. Infection is rare, happening in about one in two hundred people who have ACL reconstruction. You’ll have IV antibiotics at the time of surgery to try and prevent it.