Anterior Cruciate Ligament (ACL)Surgery

Anterior Cruciate Ligament Reconstruction Surgery

The operation is performed when there has been injury to the anterior cruciate ligament resulting in instability (or giving way). This ligament is found inside the knee. It does not heal by repair and is best treated by reconstruction. This means using another tendon to replace the injured ligament. The tendon can be taken from your hamstrings (called autograft), or from another person (called allograft).

Summary of the surgical procedure

The surgery will be performed under general anaesthetic. In simple terms, the surgical technique is as follows:

I will take hamstring tendon from your leg through an approx. 5cm incision near your knee. Through the same small incision, I will drill a hole in the tibia bone, and also the femur bone. Through the hole, I will fix the hamstring to replace (or reconstruct the ACL). I will plan to use the ‘Artherx Tightrope RT’ device on the femoral side, and a ‘Biocomposite’ or ‘PEEK’  screw on the tibia to fix the hamstring graft. This will result in improved stability for your knee. The operation will take about 1.5-2 hours.

I will also treat other problems (for example meniscal or cartilage problems). Rarely, significant problems may be identified that might require treatment another time. At the time of surgery,  I might find cartilage damage or arthritis. Previous trauma to the knee can lead to the development of arthritis. I will treat these as best as possible, but you may have long term discomfort due to this pre-existing damage. As a result, you may continue to have some pain with the knee due to this. The purpose of this operation is to provide stability to the knee so that you can undertake activities feeling safe and stable.

You will have 3 other skin incisions (or sometimes more) to put the arthroscope into the knee and instruments. The technique will be ‘key-hole’.

Risk of Surgery

Infection, DVT/PE, pain, stiffness, damage to nerves and blood vessels (including numbness around the knee), failure of the surgery to stabilise your knee.

Following Surgery

You can stay in hospital one night or go home the same day. It will be painful, but you will receive strong painkillers to help. I use a technique called enhanced recovery, injecting local anaesthetic around the surgery site to reduce post-operative pain. Over the first 2 weeks, you will need to rest your leg, and ice it to help reduce the swelling. You will need crutches when you go home. I hope that you stop using crutches by 3 weeks. The wound needs to be kept clean and dry for 2 weeks. I do not normally use a brace following surgery.

You should not do contact sports for 9 months to allow the graft to heal fully.