Do I need to have an ACL reconstruction?
An ACL reconstruction is not a necessity after an ACL tear and after a period of time and rehabilitation many people can return to their normal lives with little-to-no limitations. It is even possible to return to some level of sport without an ACL. Yet, there is a risk that living without an ACL can cause damage to other structures in the knee and could result in early development of osteoarthritis. There is a current trend in trying to manage ACL injuries without surgery, and while this conservative management can be successful it is not necessarily the best option for everyone and there is limited research on the effectiveness of this approach in the long-term.
Is there anything to be done before an ACL reconstruction?
In preparation for an ACL reconstruction it is important to try to reduce the amount of swelling, increase the range of movement, and strengthen the muscles around the knee as much as possible. It can usually take a few weeks for this to be achieved. Our sports medicine doctors or orthopaedic specialists may refer you on to a physiotherapist to help you prepare for surgery by undergoing a structured pre-operative program.
Physiotherapists may use a combination of manual therapy and exercise to regain full range of movement and improve muscle function before surgery. Ensuring that the muscles are working well pre-surgery can help to achieve a more successful outcome following surgery.
Prior to the surgery, a physical examination will be carried out at a pre-admission clinic where past medical history, current medications and measurements such as blood pressure, heart rate and oxygen saturation will be taken. This is to ensure that it is safe to proceed with the planned surgery. The pre-admission clinic also provides the opportunity to ask any further questions and to discuss final preparations for the surgery.
What happens during an ACL reconstruction?
It is not possible to repair a torn ACL by stitching it back together, but it can be reconstructed by attaching or grafting new tissue on to the old, torn ACL. The ACL is typically reconstructed by using part of a tendon from another area of the leg. The most commonly used tendons come from the hamstrings or from the patella (knee cap) tendon. Occasionally a donor graft (a tendon that has come from another person) or a synthetic graft may be used. Each type of graft has its own advantages and disadvantages, and the decision surrounding which graft to choose can often depend on post-surgical goals or surgeon preference.
The surgery is performed under general anaesthetic, so you will be completely unconscious during the surgery. If for some reason you are not able to tolerate general anaesthetic, it is possible to have a spinal anaesthetic where you will be conscious but unable to feel any pain. This will be discussed with you by the anaesthetist before the surgery.
Once you are under anaesthetic the surgeon will examine the knee arthroscopically (via keyhole), by inserting a small camera through small incisions at the front and sides of your knee. This will allow them to assess the extent of the injury to the ACL and to see if any other structures are injured. The surgeon will then remove the graft tendon and pass it through a small tunnel that has been drilled diagonally through the bone so that the graft is positioned in the same place as your old ACL. The graft is then attached by using small screws or staples that will remain in the knee permanently.
If the surgeon has found that there is damage to any of the other structures in the knee, they will then be able to make a decision whether to address these at the same time as reconstructing the ACL or to possibly perform a second surgery at a later stage. This is all dependent on the nature and extent of the injuries. It is normal for surgeons to perform debridement of the cartilage at the same time as an ACL reconstruction if indicated. This essentially means that they are “cleaning up” any small cartilage tears or loose tissue in the knee, and it doesn’t usually affect the healing time following surgery.
After the reconstruction, if the surgeon is happy with the knee movement, they will close the incisions with stitches, staples or glue and you will be transferred to the ward.
The whole procedure usually takes between one to two hours.Recovery following an ACL reconstruction