Anterior Cruciate Ligament (ACL) Surgery
ACL surgery is performed when there has been injury to the anterior cruciate ligament and either the knee is unstable (instability or gives way) or there are other significant injuries that need to be treated at the same time.
This ACL ligament is found inside the knee. When partially injured, the knee can remain stable. If so, then non-operative treatment could be successful. If it is completely ruptured and there is associated instability, repair may be indicated because the ligament is unable to heal by itself. Instead, reconstruction replaces the damaged ACL by using other tendons tissue – such as hamstrings or patellar tendon. The hamstring can be taken from the knee at the same time, or obtained from the other knee or donor tissue (called allograft).
TREATMENT OPTIONS FOLLOWING AN ACL INJURY
The treatment options for an ACL injury include: Doing nothing and using pain relief. Rest, ice, compression and elevation can help with swelling and the initial injury. Physiotherapy can help with range of motion and strengthening which can improve stability. These options are suitable in certain situations.
Persisting instability and/or those wishing to return to sports that involve pivoting may benefit from early ACL reconstruction. There is evidence that outcomes are better following early ACL reconstruction. Also, ACL reconstruction would be recommended where there is injury to other ligaments or tissues such as the menisci (either meniscus).
ABOUT THE SURGICAL PROCEDURE
The surgery is normally performed under general anaesthetic. Here is a summary of how Mr Asopa performs the surgery:
Mr Asopa harvests the hamstring tendon from the knee undergoing reconstruction through approximately a 5cm incision below and inside the knee joint. Through this same small incision, he will drill a hole in the tibia bone, and the femur bone. Through the hole, he will fix the hamstring to replace (or reconstruct) the ACL. This will result in improved stability for your knee. The operation will take about 1.5-2 hours.
Other ligament, articular cartilage or meniscal injuries will be treated at the same time. Rarely, significant problems may be identified that might require treatment another time.
It is sometimes possible to find unexpected cartilage damage or arthritis at the time of surgery. This may have resulted from previous trauma or a longstanding unstable knee. These are treated as best as possible, but you may have long term discomfort due to this pre-existing damage.
The purpose of this operation is to provide stability to the knee so that you can undertake activities feeling safe and stable.
You will also have three or more other skin incisions to put the arthroscope into the knee and instruments. The technique will be ‘key-hole’.
Pre-rehabilitation exercises can help with improving the strength of your knee before surgery.
THE DAY OF SURGERY
- You will see Mr Asopa on the day of your operation, before surgery. He will again talk to you about the planned procedure, and risks/benefits of surgery. He will also draw an arrow on your leg to confirm the side undergoing surgery.
- You will also see your anaesthetist before surgery. They will discuss anaesthetic options with you. These may include general or regional anaesthetic.
- The nurses will prepare you for the operation, including giving you advice about getting ready to go to theatre.
- The surgical procedure takes approximately 1.5–2 hours.
- Near the end of the operation, the tissues around the knee will be injected with local anaesthetic to reduce the pain.
- Once the operation has finished, you will go to recovery. You will stay here until the nursing team are happy with your progress.
- When you have safely recovered from the anaesthetic, you will be taken to the ward.
- You will experience pain after the surgery, but you will receive strong painkillers to help.
- You are likely to go home the same day (but may need to stay in hospital for one night).
- You will be given guidance and information before discharge from hospital.
- During the first 2 weeks, you will need to rest your leg, and ice it to help reduce the swelling.
- Icing should be done for 15 minutes every hour. The ice should be wrapped in cloth and not directly applied to the skin. Alternatively, devices are available to purchase online at a reasonable cost. Professional systems are also available for hire.
- The wound needs to be kept clean and dry for 2 weeks.
- Rehabilitation usually starts 2 weeks after surgery (information will be given regarding rehabilitation).
- You will need to use crutches when you go home, which you should be able to stop using after 3 weeks.
- Mr Asopa does not normally provide a brace following surgery.
- You will need to avoid contact sports for 9 months to allow the graft to heal fully.
RISKS OF SURGERY
Risks of ACL surgery include infection, blood clots (deep vein thrombosis and pulmonary embolism), pain, stiffness, damage to nerves and blood vessels (including numbness around the knee), failure of the reconstruction and/or the surgery to stabilise your knee.
Rehabilitation will be required after surgery. A guide to the rehabilitation process for ACL surgery can be found here.
The wound will be reviewed two weeks after surgery to ensure that it has healed without complication. This can either be by a nurse or surgeon.
A follow-up review six weeks following surgery is helpful to assess your progress.
Mr. Asopa recommends rehabilitation to help with recovery. He also advises not to return to contact sports until 9 months following the reconstruction surgery.
The timescales for recovery can vary but a rough guide is as follows:
– 2-3 weeks: walk without crutches.
– 6 weeks: you will have better range of motion and strength in the knee. You will be able to walk better.
– 9-12 weeks: cycling and running on the spot will be possible.
– 6-9 months: return to non-contact sports.
– 9 months: return to contact sports.
You will need to use crutches when you go home. These are normally required for the first 2-3 weeks. Remember that everyone is different and you may require crutches for longer if other procedures are carried out at the same time.
The operation will take approximately 1.5-2 hours.
Book your Appointment
with Mr Vipin Asopa
Mr Asopa performs ACL repair and reconstruction surgery in hospitals across London and Surrey. To book an appointment or for any questions or information, please contact Mr Asopa's Medical Secretaries Mandy and Mary by phone or email: