ACL reconstruction: FAQs
On this page, we cover the following questions that was frequently asked by people considering ACL reconstruction surgery:
- Will I be able to play sport again?
- Which is the best type of graft?
- What are the risks of an ACL reconstruction?
- When can I start with normal daily activities?
- Will my ACL reconstruction be successful?
- Where can I go for treatment after my ACL reconstruction?
Will I be able to play sport again?
Many people that have an ACL reconstruction are able to return to their previous level of the sport. This will take a few months of structured rehabilitation, as will be discussed later, but it is certainly achievable. However, there is a risk in some people that they might not be able to return to their previous levels of competition or possibly not be able to return to their chosen sport at all. This will often depend on a combination of factors that might affect their recovery.
Which is the best type of graft?
The graft that is used for an ACL reconstruction can either be an autograft, meaning that it is your own tissue or an allograft that is a graft taken from a donor (usually a cadaver). The two most common sites of an autograft are the patella and hamstring tendons. Each graft type has its own advantages and disadvantages.
The patella tendon is thought to closely resemble an ACL and the procedure used during the surgery means that part of the tendon, as well as small bits of bone, are used, which some surgeons prefer as it allows for “bone to bone” healing. As there is some bone removed for this type of graft there is a risk that the knee cap can be weakened, and it is fairly common to experience pain at the front of the knee for a long-time following surgery.
Using the hamstring tendons means that the pain at the front of the knee is not an issue and pain, in general, is thought to be better managed when using the hamstrings. The incision needed for the graft is also smaller than that needed for the patella tendon. The disadvantage with using the hamstrings is that there is no “bone to bone” healing and this can mean that the graft can take a longer time to heal, so would need protection for a longer period of time. The hamstring is also weakened during the surgery and can be injured more easily soon after surgery and during the rehabilitation process.
An allograft is more commonly used in recreational athletes or people that are having a revision reconstruction due to the failure of the initial surgery. Using an allograft usually means that the surgery time is shorter and that there is no need to remove other tissues for the graft, so there can be less pain following surgery. However, an allograft has a higher risk of infection and it is often weaker than an autograft due to the process that it has to undergo to be sterilised.
The type of graft that is used will be discussed with you by your surgeon and can depend on the extent of the injury, surgeon or patient preference, and the level of function or activity that you are wanting to return to.
What are the risks of an ACL reconstruction?
As with any type of surgery, there are always risks. The likelihood of these risks being increased will depend on your past medical history. However, all risks will be fully considered prior to your surgery by your surgeon and anaesthetist, who will have a plan in place to minimise these. Some of the risks associated with knee surgery include:
- Infection: The risk of developing an infection is small due to the sterile operating theatres and small incisions that are required for a knee arthroscopy. You will be given antibiotics during your surgery to reduce the risk of developing an infection.
- Blood clot: The risk of a blood clot forming is very low, and if the surgeon feels that you are at risk then you may be given a medication to prevent the formation of blood clots.
- Anaesthetic complications: This can include sickness and nausea and can be well managed should these symptoms develop.
- Pain: It is normal to feel some pain following the procedure and is a natural part of the healing process. This can initially be managed with medication and will usually start to ease with time.
- Stiffness: There is a risk of increased knee stiffness following surgery.
There are also some risks following surgery that are more specific to an ACL reconstruction. These include:
- Failure of the graft: In a small percentage of patients the new ligament, or graft, will fail and the knee will still be unstable. Failure of the graft can often be linked to factors like age and associated co-morbidities, such as diabetes and smoking history.
- Re-injury of the ACL: It is possible to re-injure the ACL graft at any stage after surgery.
- Development of OA: Osteoarthritis is a long-term effect of an ACL injury as even surgery cannot restore the natural motion to the knee, and this can result in an increased wear on the cartilage and joint surfaces.
When can I start with normal daily activities?
You will be able to continue with basic activities as soon as you are discharged home and keeping mobile, providing the knee does not become swollen and painful. As mentioned above, you will be able to put weight onto your leg almost immediately following the surgery and you will be able to be mobile with your crutches. The aim is to have you off your crutches within the first two weeks following the surgery as this will allow you to maintain strength and movement in the knee.
You will be able to wash once you are at home, but it is important that you keep the bandages and wound dressings dry. This can be done by tying a plastic packet around the knee, or by wrapping it in cling film. It may be easier to shower initially as it can be difficult to climb in and out of a bath.
Driving is only advised when you are able to walk without the use of crutches and most surgeons will advise that you wait for six weeks after your surgery before driving. You might be allowed to drive earlier if you drive an automatic. It is also important to inform your insurance company that you have had the ACL reconstruction.
The amount of time off work depends on the nature of your work. You will generally need to be off work for a longer period of time if your work is very physical. You will usually be off work for a minimum of two weeks. Our Circle Health orthopaedic surgeons will advise you accordingly regarding any relevant arrangements you need to make with your employer.
Will my ACL reconstruction be successful?
The success of your ACL reconstruction can depend on your definition of success, whether it be to reduce pain, improve stability, or return to your previous level of the sport. An ACL reconstruction is generally a successful procedure. However, there is a risk that you can re-injure the ACL graft or that you may not return to the same level of sport, or general activity, as before the injury. There is also a risk of pain in the knee despite surgery.
The factors that can affect the success of the reconstruction can include:
- The severity of the injury i.e. was only the ACL injured or was it in combination with other structures.
- Your general health. Those with poor general health are at higher risk of the surgery failing.
- Poor compliance with rehabilitation.
In order to increase the likelihood of a successful outcome and reduce the risk of re-injury, it is essential that you follow a comprehensive rehabilitation program, as discussed above, and that you make sure that you have good general health and that any other medical conditions are well controlled.
Where can I go for treatment after my ACL reconstruction?
As has been discussed, it is very important that you see a physiotherapist after your surgery to ensure that you make the best possible recovery. This should ideally be done where there are the facilities to progress your rehabilitation effectively through the various stages.
Circle hospitals provide high-quality outpatient physiotherapy at all of their hospitals and have advanced rehabilitation units at Circle Reading Hospital and at the forthcoming Circle Birmingham Hospital. Circle Rehabilitation offers accessible physiotherapy with state-of-the-art equipment and facilities that allows them to provide top quality pre-operative and post-operative knee rehabilitation so that you can regain your independence as quickly as possible.Find out more about our rehabilitation services Do I need to have an ACL reconstruction?