ACL Reconstruction Surgery
Anterior Cruciate Ligament (ACL) injuries are common, especially in individuals who participate in high-impact sports and activities. ACL reconstruction surgery may be necessary to restore knee stability and function after a tear. Understanding the nature of ACL injuries, the surgical process, and recovery is crucial for making informed decisions about your treatment.
What is an ACL Injury?
The Anterior Cruciate Ligament (ACL) is a crucial ligament in the knee that connects the thigh bone (femur) to the shin bone (tibia). It provides stability and prevents excessive forward movement of the shin bone.
ACL injuries typically occur during activities that involve sudden stops, changes in direction, or twisting motions, such as:
- Soccer
- Skiing
- Basketball
- Tennis
- Falls
An ACL tear can be partial or complete. Accurate diagnosis through an MRI scan is recommended to determine the extent of the injury and guide treatment decisions.
Types of ACL Injuries
ACL injuries are categorised based on the extent of damage to the ligament. Understanding the different types is advisable for determining the appropriate treatment approach.
Partial Tears
Partial ACL tears may involve incomplete tearing of the ligament fibres. In these cases, some of the fibres may remain intact, providing some stability to the knee. Depending on the extent of tear, these injuries may sometimes be managed conservatively with:
- Physiotherapy
- Bracing
- Strengthening exercises
Complete Tear
Complete ACL tears involve a full rupture of the ligament, leading to significant instability in the knee joint. As a result, complete ACL tears typically require surgical intervention to restore knee function and prevent long-term complications, the most significant of which is progressive cartilage damage caused by knee instability.
ACL Laxity
Another type of ACL injury which is less well-recognised is a progressive damage of the ACL ligament, leading to pain and/or progressive instability. Typically, an MRI may show that the ACL fibres are still structurally intact, but there may be laxity or pain on clinical testing.
Symptoms and Diagnosis of ACL Injury
Recognising the signs of an ACL injury is crucial for seeking timely medical attention and preventing further damage. These symptoms may manifest as:
- Sudden pain and a feeling of instability in the knee following an injury.
- Swelling, which typically develops within 24 hours.
- Limited range of motion and difficulty walking.
- A “popping” sensation at the time of injury.
- As mentioned earlier, progressive injuries may cause exertional pain and recurrent swelling with exercise, even without a specific injury event.
To confirm an ACL injury, our knee specialist will assess your knee’s stability, range of motion, and tenderness. Specific tests, such as the Lachman test or Anterior Drawer test will be performed to check for excessive movement in the knee joint. We would also likely conduct imaging tests like MRI to evaluate the extent of ligament damage with or without an X-ray to rule out any associated bone injuries, such as fractures.
Straight Leg Raise exercises that you should do before the surgery to keep your quads strong.
A hinged knee brace. As you recover, the angle on the brace will be increased to let you bend your knee more.
Preparing for ACL Tear Surgery
When the decision has been made to undergo ACL tear surgery, adequate pre-operative preparation can positively impact your recovery and help you achieve the best possible outcome. Here’s how you can prepare:
- Apply cold compresses to your knee regularly to minimise inflammation and pain.
- Focus on regaining full extension (straightening) of your knee. This will be helpful for your post-operative rehabilitation and overall knee function.
- Perform “Straight Leg Raise” exercises to help strengthen your quadriceps muscles, which are essential for knee stability and support.
Minimally Invasive ACL Surgery: What to Expect
ACL reconstruction surgery is commonly performed using minimally invasive methods, also known as arthroscopic or keyhole surgery. This approach offers several advantages over traditional open surgery, including smaller incisions, less pain, and faster recovery.
During a minimally invasive ACL reconstruction, the surgeon will recommend the best graft option based on your needs. This may involve using your own hamstring tendons, as it’s the most common choice due to its high success rate and lower risk of infection. Alternatively, the surgeon may recommend using a donor tendon. It may be considered in certain situations, such as revision surgeries or when a larger graft is needed.
Depending on your condition, the surgeon may perform either:
Trans-portal technique:
This modern method allows the surgeon to place the new ACL graft in an anatomical position, meaning it replicates the shape and structure of the original ligament, as compared to a traditional trans-tibial technique.
Single-bundle or double-bundle reconstruction
The surgeon will choose the most suitable method based on your anatomy and specific needs. Generally, single-bundle reconstruction effectively restores knee stability and function for most patients. Double-bundle reconstruction offers slightly better rotational stability, making it more common for professional athletes, but it typically requires a longer recovery period.
If the surgery involves using your hamstrings, our surgeon will make a small incision (3cm) on the upper inner side of your shin bone to harvest the hamstring tendons. Small incisions (around 0.5-7 cm) are then made at the front of your knee to insert the arthroscope (camera) and surgical instruments. The harvested tendons or allograft are prepared and passed through the bone tunnels created by the surgeon. They are then securely fixed in place to recreate the function of the ACL. Over time, the graft will gradually integrate with your bone, restoring stability to your knee.
What Happens on the Day of Surgery?
On the day of surgery, you will be admitted to the designated hospital at least 2 hours before the surgery time. You’ll receive general anaesthesia, so you’ll be asleep during the surgery. The actual ACL reconstruction surgery typically takes about 1.5 hours, but patients may be in the operating theatre for 3 to 4 hours. This is due to the pre-op preparation and post-op monitoring.
After the procedure, you’ll receive pain medication to manage any discomfort. A hinged knee brace will be placed on your knee to restrict movement and protect the graft. The medical team will provide detailed instructions on wound care, pain management, and activity restrictions. Most patients stay overnight in the hospital for observation and pain management.
Recovery After ACL Surgery
Recovering from ACL reconstruction surgery requires time, dedication, and a structured rehabilitation plan. Here’s a breakdown of the recovery process:
Rehabilitation Process
Physiotherapy plays a vital role in regaining strength, flexibility, and stability after an ACL surgery. It typically starts around 2 weeks post-operation and may continue for several months. Your physiotherapist will guide you through the exercises to improve your range of motion, strengthen your muscles, and restore normal movement patterns. Consistent attendance and active participation in physiotherapy sessions are recommended for optimal outcomes.
General timeline for recovery:
- 1 Month: You should be walking fairly comfortably with minimal assistance.
- 3 Months: You can progress to brisk walking, swimming, and cycling.
- 4-4.5 Months: You may be able to start jogging and light running.
- 8-9 Months: With clearance from your surgeon, you can gradually return to pivoting and jumping sports.
However, you’ll likely need crutches for the first 2 to 4 weeks after an ACL surgery to assist with walking and protect the graft. If you have stairs at home, it’s advisable to minimise climbing and use handrails for support. If possible, have someone assist you. Make sure your home is safe and free of obstacles to prevent falls and facilitate your movement with crutches.
Driving
If your surgery was on your left knee and you drive an automatic car, you may be able to resume driving within 2 to 3 weeks. If your surgery was on your right knee or you drive a manual car, it may be 4 to 6 weeks before you can safely return to driving.
Time away from work
The time needed to return to work varies depending on the physical demands of your job. Most patients require 2 to 6 weeks off work. Discuss your specific situation with your surgeon and employer to plan your return to work accordingly.
Prevention of ACL Injuries
While not all ACL injuries are preventable, taking proactive steps can help reduce your risk, especially if you participate in sports or activities that put stress on your knees.
- Always warm up your muscles before engaging in any strenuous activity. This increases blood flow to the muscles and prepares them for the demands of exercise.
- Include dynamic stretches that mimic the movements you’ll be performing, such as leg swings, high knees, and butt kicks.
- Focus on exercises that strengthen the muscles surrounding your knee, particularly the hamstrings and quadriceps.
- Include exercises that improve neuromuscular control, such as single-leg squats, lunges, and plyometrics.
- Strong leg muscles provide better support for your knee and help stabilise the joint, reducing the risk of ACL injury.
- Wear shoes that provide good support and traction for your chosen activity.
- Replace worn-out shoes regularly, as they may not provide adequate support.
- When jumping or landing from a jump, focus on landing softly with your knees bent and your feet shoulder-width apart.
- Avoid landing with your knees straight or collapsing inward.
- Pay attention to any pain or discomfort in your knee.
- Don’t push yourself beyond your limits, and rest when needed.
See an ACL Specialist Today
If you’ve experienced a knee injury and suspect you may have torn your ACL, feel free to seek professional help. Early diagnosis and treatment are recommended for a successful recovery and preventing long-term complications. Don’t let an ACL injury sideline you. Consult our orthopaedic specialist today to discuss your treatment options and take the first step towards recovery.
Frequently Asked Questions About ACL Reconstruction Surgery
How long is the recovery process?
Full recovery from ACL surgery typically takes 6 to 9 months, but it can vary depending on individual factors such as the severity of the injury, the type of graft used, and your commitment to rehabilitation.
What are the costs of ACL reconstruction surgery?
The cost of ACL surgery in Singapore can vary depending on several factors, including the type of graft used, the exact procedure done, and the hospital where the procedure is done. Singapore Ministry of Health publishes typical bill sizes on its website. It’s advisable to discuss the cost with your surgeon and insurance provider to get a clear understanding of the expenses involved.
Can ACL tears heal without surgery?
While some partial ACL tears may stabilise with conservative treatment like physiotherapy and bracing, complete ACL tears generally require surgical reconstruction to restore knee stability and prevent long-term complications. However, non-surgical options may be acceptable for older individuals with less active lifestyles or those who are not candidates for surgery.