ACL Reconstruction in Surrey

What is involved in ACL Reconstruction?

An anterior cruciate ligament (ACL) reconstruction is a procedure whereby a donor graft is placed within the knee and secured to the femur and tibia within sockets or tunnels, providing stability to a previously unstable knee joint.

The first stage is to examine the knee while the patient is under anaesthetic, to detect whether a deficient or torn ACL is the cause of your knee pain or discomfort. If this is confirmed, preparation of the donor graft commences.

There are many options when considering graft choice, all of which have pros and cons.  Each type can be created and used in different ways to restore the stability of the knee. Any regarding which graft is best is based entirely on individual patient circumstances, including the type of injury and the activities you may wish to return to. We will discuss with you in detail which graft option would be  most appropriate for you.

The main part of this type of knee surgery is carried out arthroscopically (keyhole). Once the graft is ready, and its size has been determined, sockets or tunnels are drilled using so the graft is inserted in a way that replicates the original anterior cruciate ligament. The graft is then secured in place, the knee checked for stability, and then the wounds are closed, normally with dissolving sutures.

Why might I need an ACL reconstruction?

The anterior cruciate ligament is one of the main stabilising structures in the knee joint, and is often ruptured or torn as part of a twisting or hyperextension injury. This can be the only ligament affected, though sometimes you can injure other ligaments and need a multiple ligament repair instead.

This is often sports-related, and is fairly common in players of  football, netball and skiing. In some circumstances, the knee will be grossly unstable, and should you wish to return to a high level of activity, you may  require ACL reconstruction, to prevent the knee giving way during sporting or day to day activities.

On other occasions,  your knee may feel reasonably stable on a day-to-day basis, and your surgeon may recommend treatment that avoids surgery. 

What happens after surgery?

This type of operation is normally carried out under general anaesthesia, with local anaesthetic and potentially nerve blocks around the knee, to try and help with post-operative pain relief.

Immediately following the procedure, you will have dressings on the knee and a special cooling knee cuff to reduce swelling and post-operative pain. Once you have recovered from the anaesthetic, our expert physiotherapy team will visit and get you up and walking.

Early mobilisation and weight-bearing helps to reduce the risk of venous thromboembolism (blood clotting) and improves muscle rehabilitation. Once the physiotherapy team is happy with your mobility, your pain is under control, and you are fully recovered from the anaesthetic, you will be able to go home.

ACL reconstruction is often carried out as a day-case procedure, but occasionally patients will stay overnight, to have physiotherapy or pain medication if required.

After you have been discharged, we will organise a follow-up appointment around 2 weeks after surgery to remove the dressings, check the wounds,  and asses the range of movement in your knee. You will then have regular follow-up appointments to ensure your knee is recovering as we would expect. 

Recovering from ACL Reconstruction

Week 1 to 2: 

It is important to rest the knee and elevate the leg to allow the swelling to reduce.

You will need to take regular painkillers and anti-inflammatories and continue regular ice therapy. This allows the swelling or effusion within your knee to settle, and as the pain improves, you will gradually be able to work on regaining your range of movement.

It is also important to perform static quads exercises to stop the quadriceps muscle from disengaging and wasting away. We will give you all the information you require on this before you are discharged.

We recommend that you seek advice from a physiotherapist within the first 2 weeks of your surgery to commence your rehabilitation protocol.

Weeks 2 to 4:

To help reduce swelling, you should continue to use ice therapy and compression techniques.

You will also be encouraged to increasingly bear your full weight on the knee, and perform exercises to improve mobility and increase muscle tone and control.

Once your wounds have healed, we will encourage you to do hydrotherapy and use a static bike for your rehabilitation. All of this will be explained to you, after surgery and before you leave the hospital.

Weeks 4 to 12:

Any pain should fully subside and your range of knee movement should return to near normal.

The swelling should also completely disappear, and your walking should return to normal. It would help if you also continued with any exercises recommended by our physiotherapists, to improve the strength and tone of your muscles continually. This will also help to improve your coordination.

Months 3 to 6:

We will aim to maximise the tone and power in the muscles of your core and lower limbs. You will probably move on to doing more intense exercises, to improve your neuromuscular control and overall fitness.

You should return to contact or change-of-direction-type sports no earlier than 9 months after surgery. 

Regardless of your recovery up to this point, the blood supply to the graft will not be fully established, making your knee vulnerable to further injury.

Frequently asked questions

Do I need an anterior cruciate ligament reconstruction?

Whether or not someone requires an ACL reconstruction is highly variable. There are pros and cons to operative and non-operative approaches. You will be able to discuss with your surgeon, the best approach and procedure for your unique circumstances.

Which graft will be used?

There are multiple graft options, including allografts (donor) and autografts (from your own body). We will discuss with you which option is going to be best for your knee. 

How long until I can drive after ACL surgery?

This somewhat depends on which leg has been operated on, and whether you drive a manual or automatic vehicle.

If we have operated on your right leg, it will usually be between 4 and 6 weeks before you can drive. We advise you to inform your car insurance company, to ensure they have no further restrictions.

How long until I can run after ACL Repair?

This is very patient-specific. Before you resume any sort of high-impact activity, we need to be sure that you have good neuromuscular control, balance and coordination.

Our physiotherapy team will be able to advise you on this, during the course of your rehabilitation.

As a guide, you can normally expect to return to running somewhere between 3 and 6 months after surgery.

When can I ski?

We would normally recommend not skiing for 9 months after surgery, as an absolute minimum.

When can I return to sports?

Non-contact or non-twisting sports, such as cycling, swimming (not breaststroke), and jogging, can be resumed between 3 and 6 months after surgery.

Sports that involve contact or significant changes in direction, should not be resumed before 9 months, at the very least. 

What are the chances of re-injury?

Research suggests this is unlikely and occurs only in around 10 per cent of cases.  Modern surgical techniques mean the risk is reducing all the time, but if you return to activities that put stress on the knee too soon, there is a significant chance of re-injuring your knee.

Will my graft have an impact on my long-term activity?

Depending on which type of graft has been used, there may be minor impacts on the function of that tendon. Normally, this is not perceivable on a day-to-day basis.

Am I more likely to get arthritis following ACL reconstruction?

Evidence shows that patients who have ruptured their anterior cruciate ligament are more likely to develop knee arthritis in later years. There is no strong evidence to suggest that having an ACL reconstruction either increases or reduces these risks.

However, if your knee remains unstable following an ACL injury, and this is not addressed, further damage to other parts of the knee is likely. This will  increase the risk of arthritis developing in the future.