ACL Reconstruction Surgery & Injury Treatment

Mechanism of Injury

Injury to ACL involves non-contact pivoting injury. If the foot remains planted whilst the upper body twists excessively, it can result in ACL injury. Occasionally, it can also occur during hyperextension injury.

ACL injury is commonly seen after sporting injuries i.e. football, rugby, tennis, skiing, snowboarding, badminton, netball, etc. However, it is not uncommon for ACL to be injured during day-to-day activities.

Clinical Presentation

Knee joint often swells up soon such an injury. It is often difficult to carry on with the sporting activity. Weight-bearing on the affected leg can be difficult for a few days.

Once the initial pain and swelling settle down, the knee generally feels quite lax and one can lose confidence from the knee. Most patients develop giving way sensation in the knee joint. This can affect one’s ability to participate in any strenuous/sporting activity. Occasionally, some patients develop instability even on day-to-day activities.

Management of ACL Injuries

Early clinical assessment by a specialist knee surgeon is recommended for patients with suspected knee ligamentous injury.

During the initial consultation, diagnosis is established by thorough history taking and appropriate clinical examination. X-rays are often taken to rule out any bony injury. MRI scans help confirm the clinical diagnosis. Initial management in most cases includes physiotherapy, splinting, advice regarding exercises, and analgesia.

During subsequent review/follow up with the specialist, if there are symptoms/signs of knee instability, surgical reconstruction of ACL can be considered.

ACL Reconstruction Surgery

The torn ligament is reconstructed generally using autografts (tissue from the patient’s own body). ACL can be reconstructed using hamstring tendons or using part of the patellar tendon with a piece of bone on either side. Results from both these techniques are reproducible and excellent. However, the use of the patellar tendon is associated with the risk of anterior knee pain (pain in front of the knee) due to the scar. For this reason, the use of hamstrings to reconstruct ACL is widely regarded as the gold standard. I routinely use hamstring tendons to reconstruct ACL. I occasionally use patellar tendon graft in specific circumstances.

The surgery in my hands is an all-arthroscopic technique (an entire procedure carried out with keyhole procedure). This facilitates early rehabilitation and speedy recovery

Risks and Benefits

Benefits of ACL reconstruction surgery include improved knee stability and the ability to return to full sporting ability.

Risks of this surgery include risk of infection (<1%), bleeding, DVT (clots in your lower leg), PE (clots going to your lung), numbness around the scar, and some residual laxity.

Rehabilitation and Recovery

You will generally be admitted to the hospital on the day of the surgery. Most patients stay in the hospital overnight and are safe to be discharged the next day.

You will be allowed to fully weight bear on the leg using crutches. You can start weaning off the crutches generally after 2 to 3 weeks. No splint is necessary. Driving can be recommenced as soon as independent mobility is achieved.

Post-operative physiotherapy is commenced whilst in the hospital followed by outpatient physiotherapy as deemed appropriate for each patient.

Initial recovery phase is around 4 to 6 weeks, followed by further rehab and physiotherapy and full recovery including a return to sports can be achieved by about 6 months in most cases.

• Hamstring Tendon Graft Reconstruction of the ACL

Frequently Asked Questions

Q1. What is ACL Reconstruction Surgery?
ACL reconstruction surgery replaces a torn anterior cruciate ligament (ACL) in the knee with a healthy tendon graft, often taken from the patient’s hamstring or patellar tendon. The procedure uses minimally invasive techniques with a camera (arthroscope) to replace the damaged ligament with a new graft to restore knee stability, mobility, and function.

Q2. What is the recovery time for ACL reconstruction surgery?
ACL reconstruction recovery varies, but return to daily activities usually occurs within a few months, while returning to non-contact sports can take 6-12 months, and contact sports typically require 9-12 months or longer, focusing on meeting rehabilitation criteria rather than just time.

Q3. What is the best treatment for an ACL injury?
Treatment for an ACL (Anterior Cruciate Ligament) injury depends on the severity, age, lifestyle, and health of the individual, but generally involves the RICE method (Rest, Ice, Compression, Elevation) for initial care, followed by physiotherapy to restore strength and movement, or in more severe cases, surgical reconstruction.

Q4. What is the cost of ACL surgery in UK?
In the UK, the cost of private ACL surgery generally ranges from approximately £5,000 to £12,000, but this can vary significantly depending on the hospital, consultant, and location.

Q5. Which medicine is best for ligament repair?
There isn’t a single “best medicine” for ligament repair, as treatment depends on the severity of the injury and may include pain relievers like paracetamol or ibuprofen for initial symptoms, anti-inflammatory drugs to reduce swelling, or even advanced treatments like platelet-rich plasma (PRP) or stem cell therapy for more severe tears.

Q6. What is the fastest way to recover from ACL surgery?
The fastest way to recover from ACL surgery involves diligently following a structured physical therapy plan, managing swelling with the RICE method (Rest, Ice, Compression, Elevation), maintaining proper nutrition with a protein-rich diet, getting adequate sleep, and supporting your mental recovery.

Q7. What is the best medicine for an ACL injury?
There isn’t a single “best” medicine for an ACL injury, but nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are recommended for pain and swelling, with acetaminophen used for pain only.

Q8. Which type of ACL reconstruction is best?
There isn’t one “best” type of ACL reconstruction, as the ideal choice depends on the patient’s age, activity level, and individual anatomy, but autografts (using your own tissue) are generally preferred, with the Bone-Patellar Tendon-Bone (BPTB) autograft historically considered the gold standard for its stability and high return-to-sport rates.

Q9. What is the physical exercise for ACL injury?
Physical exercise for ACL injuries includes range of motion (ROM) exercises like heel slides and stationary cycling, strengthening exercises such as quad sets, hamstring curls, and hip bridges, and balance and proprioception training like single-leg balance. Exercises progress from low-intensity movements to controlled strength and agility drills, always following a doctor’s or physical therapist’s guidance to ensure a safe and effective recovery.

Q10. What is the hardest part of ACL recovery?
The hardest part of ACL recovery is the combination of physical and mental challenges, particularly the fear of re-injury when the graft is weakest (6-12 weeks post-op) and the potential mental block around returning to high-impact activities like jumping and cutting, even when physically ready.

Q11. What foods should you avoid after ACL surgery?
After ACL surgery, you should avoid foods that increase inflammation and slow healing, such as excessive sugar and refined carbohydrates, alcohol, and highly processed foods like fast food and chips.

Q12. What to wear after ACL surgery?
After ACL surgery, you’ll likely need to wear a brace and use crutches as instructed by your surgeon or physical therapist. For comfort, wear baggy shorts, comfortable dresses, or loosely-fitting sweatpants that can accommodate the brace, and closed-toe sneakers.