ACL Reconstruction Surgery is a type of knee surgery that is performed to reconstruct a torn anterior cruciate ligament. When the ACL is damaged, it can be a very debilitating injury that causes knee instability, swelling and limited mobility.
Mr Punwar performs many complex knee surgeries every year, including ACL reconstructions and partial knee replacement surgeries. If an operation can be avoided, Mr Punwar will always explore other options with his patient.
The aftercare for ACL is as important as the operation, so that a patient regains stability, avoids any additional procedures and can return to sporting activities. Mr Punwar delivers a comprehensive aftercare programme, and will continue to see patients at regular points after the surgery, keeping a close eye on their recovery.
ACL Reconstruction surgery involves taking a graft, normally using hamstring tendons, to replace the ACL, which does not heal by itself. The graft is passed through tunnels in the shin and thigh bones and then fixed to the bone at each end. The procedure is done arthroscopically (keyhole surgery) where a small camera is inserted into the knee.
You will have a general anaesthetic, so you will not feel anything throughout the operation which normally takes around 90 minutes to perform. ACL reconstruction surgery is typically performed as a day case but on occasion a patient would need to stay in until a suitable strength is regained.
What is the ACL?
The ACL is located in the middle of the knee and attaches the shin bone (tibia) to the thigh bone (femur). Its purpose is to stop the shin bone from sliding forward on your thigh bone, and to give the knee rotational stability.
How is the ACL normally injured?
The ACL is typically injured in sports which involve pivoting, such as football, netball, basketball and rugby. This normally happens when the foot is planted and the body suddenly changes direction, typically a twisting inwards motion away from the knee.
There can be a partial or total rupture of the ligament, and sometimes damage to other structures of the knee such as the menisci, the body’s natural shock absorbers, in which case Mr Punwar can also carry out meniscal repair. There may also be damage to the collateral ligaments around the knee.
What are the consequences of an ACL injury?
When the ACL is ruptured, there is immediate pain, swelling and you often feel a ‘pop’. The pain worsens when trying to stand up and put weight through the knee, so it is very unlikely that you could carry on playing sport once this happened. The pain is typically so severe that you would visit an emergency department or A&E.
The immediate aftercare would involve rest, ice, compression and elevation (RICE). Once the swelling had gone down, a knee specialist should examine the knee and perform tests including an Anterior Drawer and Lachman’s Test to diagnose the ACL injury. An MRI would then be ordered to confirm the diagnosis, which would show the ACL tear quite clearly as well as other injuries within the knee.
What happens before ACL Reconstruction surgery?
Before surgery can occur, the patient would need to regain their range of motion.
It takes between 6 weeks to 3 months after the injury happens for the swelling to be down enough to be ready for surgery. Also, the more flexible and stronger someone is before surgery, the better the recovery is afterwards.
Are there any alternatives to ACL Reconstruction surgery?
There will always be a discussion around all the options available, and these will depend largely on a patient’s individual needs, the risks and the benefits. Rehabilitation, normally in the form of physiotherapy to strengthen the leg, is carried out before deciding if the ACL needs to be reconstructed. However, if the knee has become unstable, then reconstruction surgery would be needed. If the patient wishes to return to the same level of sporting activity as they enjoyed before then a carefully planned ACL reconstruction is often required.
What follow-up care is provided?
Two weeks after the surgery, the dressing would be changed and there would be a check that the wound has healed. Then at six weeks, there would be an x-ray to check on the alignment of the implants, as well as a check of the range of motion, and any complications.
Physiotherapy is critical to the recovery of an ACL surgery, and 3-months following surgery, some light exercise would be introduced, like light jogging. There is another review at six months, but a patient would not be able to return to any form of contact sport until they were discharged, either at the 9-month review stage, or even up to a year after surgery.
After a skiing accident last winter, Sarah Foster, a keen athlete, running coach and busy mum to a young family, needed ACL reconstruction surgery. Sarah was determined to get back to doing what she loved doing most, running. So, after researching experienced, specialist knee surgeons in London, she felt confident that her ACL surgery would […]
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