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Anterior cruciate ligament reconstruction
ACL reconstruction can improve the stability and the function of your knee following an injury. It involves replacing the ACL in your knee, usually using a tendon from another part of your body. You will meet the surgeon carrying out your procedure to discuss your care and can discuss the procedure in detail. It may differ from what’s described here as it will be designed to meet your individual needs.
What is an anterior cruciate ligament reconstruction?
The anterior cruciate ligament (ACL) is one of the two large ligaments within the knee. It controls front to back and, most importantly, pivoting or twisting movement. The ACL can be torn or ruptured during sports activities and once broken, it rarely heals and the knee may give way.
Regular giving way can lead to secondary damage to the menisci (shock absorbers) and articular cartilage (joint surface) as well as making twisting and turning difficult.
A ligament graft is required using material taken from the front of the knee or from the hamstring tendons behind the knee, both of which are able to re-grow to a large extent.
Successful ACL reconstruction will mean your knee will no longer give way and you can return to sport and everyday activities.
What does this involve?
Anterior cruciate ligament reconstruction is usually performed through keyhole surgery under general anaesthetic. You would normally be admitted on the day of the operation and some people go home the same day or have an overnight stay in hospital.
You will not be able to eat for eight hours prior to surgery although you will be able to drink small amounts of water up to four hours before.
The operation takes about one hour and your surgeon will make some keyhole incisions in your knee to allow small specially designed instruments to be introduced. The torn ligaments are trimmed and the knee is prepared for the replacement graft of suitable tissue. Part of the patellar tendon (which runs from the lower end of your kneecap to the top of your shin bone) is normally used. The top and bottom ends of the replacement ligament are fixed into place with special screws into holes drilled into your bones.
The incisions are closed with stitches or adhesive strips
When will I recover?
Recovery from the anaesthetic is rapid and you will be awake very soon after the operation although you may feel drowsy for an hour or two. You will be allowed to go home once you are weight bearing with the assistance of crutches.
You may shower with the waterproof dressing on and your physiotherapists will give you advice on how to exercise your leg before you leave and may arrange outpatient physiotherapy, if needed. You will be given a cold compress along with instructions on how to cool your knee, which is important and aids recovery. You will see your knee consultant two weeks after your operation to review your progress.
You may need to take 4-6 weeks off work and driving following the operation and your surgeon may want you to wear a knee brace for a few weeks.
When your knee has settled down, you will need to start intensive physiotherapy which may continue as long as six months.
What risks should I know about?
Anterior cruciate ligament reconstruction is commonly performed and generally safe but there can be potential complications. These only affect less than 4% of patients.
Infection can occur although our theatres have ultra-clean air operating conditions keeping infection rates at 1:1000. We give antibiotics to reduce the risk
Blood clots are rare. We use established prevention methods including aspirin.
Damage to the nerves around the knee leading to weakness, numbness or pain in the leg or foot – this usually settles on its own. Risk is less than 1%.
A break of the kneecap can occur during or after surgery but only if your surgeon uses a patella tendon graft – 1% risk.
Risk of re-rupture or stretching is 1% per year; this means that 10 years from surgery there is a 90% chance that the graft will still be functioning well.