Anterior Cruciate Ligament (ACL) Reconstruction Surgery

 

Overview

Anterior Cruciate Ligament (ACL) reconstruction is a commonly performed procedure for instability after ACL injury. Tissue is used to create a graft which is then placed through bone tunnels in the tibia (shin bone) and femur (thigh bone) to reconstruct the damaged ligament. 

The art of ACL reconstruction lies in matching the graft to your needs and placing the reconstruction tunnels in precisely the right position to stabilise your knee but avoiding over- or under-stiffening it. It is often combined with meniscal surgery or extra procedures to stabilise the knee. These will be tailored to your needs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Introduction 

Anterior Cruciate Ligament (ACL) reconstruction is one of the most commonly performed procedures. As the ACL prevents the tibia from rotating beneath the thigh bone, the main symptom is usually a sense of knee instability when attempting twisting activities. Once the diagnosis is made, Mr Howells will discuss the treatment options with you. 

Physiotherapy and activity modification may be enough to give a stable knee for some. For many others who wish to return to twisting sports, surgical reconstruction is considered. 

Once a decision has been taken to reconstruct the ACL, you will discuss the best graft choices for you, any need for additional procedures and the required personalised rehabilitation . 

 

Hospital 

You are admitted to hospital the day of surgery. The surgery is most commonly performed under a general anaesthetic. You will meet your anaesthetist and be checked in by a nurse before Mr Howells sees you to confirm your consent and mark the leg to be operated on. 

 

The Procedure 

Once you are asleep, the knee is examined to confirm the diagnosis. A small incision is then placed either over the tibia where the hamstring tendons attach or over the kneecap tendon, depending on the graft to be used. The graft is then harvested and local anaesthetic instilled. 

Two small keyhole incisions are then placed over the front of the knee and a telescope is introduced, before instruments are used to carry out the reconstruction. If any meniscal damage is found then this is addressed. If a meniscal repair is performed then you will be provided with a brace to be worn for 6 weeks, to protect the healing meniscus. This will allow the knee to flex from 0-90 degrees.

After the wound is closed and dressings applied, you will be transferred to the recovery area until you are fully recovered from the anaesthetic. The knee can be sore initially but this usually settles quite rapidly with painkillers. 

You will return to the ward and the physiotherapist will help to get you walking with crutches. You will be discharged when safe and comfortable, either the same day as surgery or the following day, depending on your pre-op plan. 

 

Progress 

Following discharge from hospital, you will see the clinic nurses at the two-week mark to check the wound. It is possible to resume a sedentary job 2 weeks after surgery if this can be done with crutches. You will see Mr Howells at around the 6 week post-operative mark. It is usually 6-8 weeks before physical work is possible. Rehabilitation is crucial  you will be guided through this by the physiotherapists. You will start fitness and strength work as early as 6-8 weeks following surgery but it is usually 12 months before unrestricted sport can be resumed. 

 

Results 

The vast majority of patients experience an uncomplicated recovery and improved knee stability with a return to normal function. 

Complications 

Infection
Deep bone or joint infection is rare but if this occurs and is untreated, serious problems follow. Any unexplained fever, wound redness or increasing pain should be reported to Mr Howells. 

 

Blood clots
Make sure you carry out your calf pump exercises regularly and drink enough fluids to remain hydrated. Unless you have specific risk factors (e.g.: previous clots, a strong family history), preventative medication is not usually required.
A clot which travels to the lung can be fatal although this is extremely rare. Chest and calf pain can be symptoms of a clot and must be reported immediately.

 

Re-Rupture
Re-injury is rare but can occur. More frequently, problems can be found with meniscal tears. These may need to be addressed through further keyhole surgery.

 

Nerve and blood vessel damage
Major nerves and arteries which supply the leg are in the vicinity of the surgery. Although rare, damage to these is possible. 

Other complications include haematoma, superficial infection and knee stiffness. Please feel free to discuss these with Mr Howells. 

Knee Anterior Cruciate Ligament (ACL) tear. Nick Howells Consultant Knee Surgeon and Sports Injury Specialist