What is the anterior cruciate ligament?
The anterior cruciate ligament (ACL) is one of two main ligaments in the knee that connect the thighbone (femur) to the shinbone (tibia). Anterior cruciate ligament reconstruction is a procedure aimed at replacing this torn ligament which is vital for providing stability and protection to the knee.
ACL ligament is at risk of tearing when you put the knee joint through unique stress. Young athletes are especially at risk of an ACL tear during sudden stops and changes in direction.
Understanding ACL Injuries
An anterior cruciate ligament (ACL) injury is a common type of knee injury that occurs when the ACL, a crucial ligament that connects the thigh bone (femur) to the shin bone (tibia), is stretched or torn. These injuries often happen during activities that involve sudden stops, changes in direction, or landing from a jump. Understanding the severity of an ACL injury is crucial in determining the best course of treatment.
ACL injuries can be classified into three grades:
- Grade 1: A mild ACL injury where the ligament is stretched but not torn. This may cause some discomfort but generally does not severely impact knee stability.
- Grade 2: A moderate ACL injury where the ligament is partially torn. This can lead to more significant pain and instability in the knee joint.
- Grade 3: A severe ACL injury where the ligament is completely torn. This often results in a loss of knee stability and requires surgical intervention.
If you suspect an ACL injury, it’s essential to seek medical attention promptly. Delaying treatment can lead to further damage and complications, making recovery more challenging.
Related Conditions
Most anterior cruciate ligament injuries occur during athletic and fitness activities that exert pressure on the knee:
- Abruptly decelerating and changing direction (cutting)
- Pivoting with a firmly planted foot
- Incorrectly landing from a jump
- Stopping suddenly
- Sustaining a direct impact to the knee
For individuals who are relatively inactive, engage in moderate exercise, or participate in sports that exert less stress on the knees, a regimen of physical therapy may effectively treat an ACL injury.
ACL reconstruction is typically advised if:
- You are an athlete wishing to continue in your sport, especially if it involves jumping, cutting, or pivoting
- More than one ligament is injured
- You have a torn meniscus requiring repair
- The injury causes your knee to buckle during daily activities
- You are young (though factors such as activity level and knee instability are more crucial than age)
Non-surgical treatment for ACL injuries
Non-surgical treatments for an ACL injury can be effective, especially for partial tears or in individuals with lower activity levels. Options include physical therapy to strengthen the muscles around the knee, bracing to provide stability, and activity modification to avoid high-risk movements. Steroid injections or PRP injections can help manage pain and inflammation, while techniques like prolotherapy may stimulate healing. These treatments are typically sufficient for people who are not highly active in sports or for those with mild instability. However, for complete ACL tears or active individuals who engage in high-impact activities, surgery is often recommended to restore full function and prevent further joint damage.
Hospital fee guide price: £6,230
Procedure price subject to bespoke quotation
*Additional consultant fee not included
Before surgery
Initially, you will come in for consultation with one of our orthopaedic surgeons. During the consultation, your surgeon will survey the knee joint to ensure that they can recommend surgery as opposed to treating the knee pain with nonsurgical treatment. To have an ACL injury diagnosed, the orthopaedic consultant will conduct a detailed health history and physical evaluation of the knee, often using imaging techniques such as X-rays and MRI to confirm the diagnosis and assess the condition of the knee joint. If surgery turns out to be the best solution for your knee pain, we will help you arrange the operation.
Pre-admission process
You may be asked to attend a pre-admission consultation before your surgery, to best prepare you for the operation.
During this consultation, your doctor will review any medications (including over-the-counter drugs and supplements) you are currently taking. You may be advised to stop taking certain medications, such as aspirin or ibuprofen, blood thinning medication or supplements in the weeks leading up to your surgery. Additionally, you will need to stop smoking, as it increases the risk of complications, like infection.
Your doctor may also perform tests, such as blood tests, X-Rays, ultrasound, or an electrocardiogram (ECG), to evaluate your overall fitness for the surgery. If you have specific health concerns, further tests might be required.
At this appointment, you will receive valuable information, including:
- Instructions on what to eat and drink before your procedure (e.g., fasting for six hours, depending on the type of anaesthetic used)
- An estimated timeline for your full recovery
- Guidance on any medications you should start or stop before surgery
- What to expect after your ACL repair
Your consultant will also discuss the potential risks of the surgery and answer any questions you may have. Finally, you will be asked to sign a consent form to confirm your agreement to proceed with the surgery.
Prehab
Prehab (prehabilitation) before ACL (anterior cruciate ligament) repair is highly recommended and can significantly improve your recovery process. While it is not strictly mandatory, doing prehab exercises before surgery helps strengthen muscles, improve joint stability, and reduce the risk of complications during and after the surgery. It also optimises the knee’s condition, making it easier to regain function after the procedure.
Prehab for ACL surgery offers several benefits:
- Strengthening Muscles: Focuses on quadriceps and hamstrings to stabilise the knee joint, reducing strain on the injured ACL and correcting muscle imbalances.
- Improving Range of Motion: Maintains knee flexibility to prevent stiffness post-surgery, making rehabilitation easier.
- Reducing Swelling: Involves techniques to minimise swelling and inflammation, aiding faster recovery and reducing pain.
- Optimising Recovery: Facilitates a quicker recovery by ensuring stronger muscles and better joint condition, enhancing post-surgery rehab.
- Minimising Complications: Reduces the risk of post-operative stiffness, weakness, or instability by strengthening muscles and teaching proper movement patterns.
During surgery
First, you will receive anaesthesia, to ensure comfort during the surgery. The knee is then cleaned and prepared for the procedure. The surgeon then selects a graft, which can either be an autograft (tissue taken from the patient’s own body) or an allograft (tissue from a donor), which is usually taken from the hamstring.
The selected graft is carefully prepared and shaped to match the patient’s ACL. Next, the surgeon creates small tunnels in the thigh bone (femur) and shin bone (tibia) to accommodate the graft. The graft is threaded through the tunnels and secured in place using screws or staples. New ligament tissue will grow onto the graft therefore restoring stability to the knee.
The incisions are closed, and the knee is bandaged to protect the surgical site.
The whole procedure usually takes 1-2 hours. You will then be moved from the operating room to an appropriate ward where you will wake from the general anaesthesia.
After surgery
Recovery and rehabilitation are crucial components of ACL reconstruction surgery. The rehabilitation process typically involves several phases:
- Immediate Post-Operative Phase (0-2 weeks): During this phase, patients are advised to rest, ice, compress, and elevate the knee to reduce pain and swelling. It is important to keep the leg elevated and avoid putting weight on the knee.
- Early Rehabilitation Phase (2-6 weeks): Patients begin to perform gentle exercises to improve range of motion, strength, and flexibility. Physical therapy often starts during this phase to guide the recovery process.
- Intermediate Rehabilitation Phase (6-12 weeks): Patients progress to more advanced exercises, including agility drills and strength training. The focus is on rebuilding muscle strength and improving knee stability.
- Advanced Rehabilitation Phase (3-6 months): Patients engage in functional training, including sports-specific drills and activities. This phase aims to prepare the knee for a return to normal activities and sports.
Following a structured rehabilitation program is essential to ensure a successful recovery and minimise the risk of complications.
Complications and Risks
As with any surgical procedure, ACL reconstruction carries certain risks and potential complications. These may include:
- Infection: Although rare, infections can occur at the surgical site.
- Blood Clots: There is a risk of developing blood clots in the legs, which can be serious if not treated promptly.
- Nerve Damage: Some patients may experience numbness or tingling around the surgical area due to nerve damage.
- Graft Failure: In some cases, the graft may not heal properly or may fail, requiring additional surgery.
- Knee Stiffness: Stiffness in the knee joint can occur, making it difficult to achieve a full range of motion.
- Patellar Tendonitis: Inflammation of the patellar tendon can cause pain and discomfort.
It is essential to discuss these risks and complications with your surgeon and follow their instructions carefully to minimise the likelihood of adverse outcomes. By adhering to your surgeon’s advice and participating in a comprehensive rehabilitation program, you can enhance your chances of a successful recovery.
Appointment and Treatment Plan
Appointment
Based on your previous consultation with a doctor, an appointment will be arranged between you and your surgeon.
Treatment plan
During this appointment, you’ll go through your medical history, the surgery, the recovery, and together, you’ll decide whether this is a viable option for you. At this stage, prehab might also be recommended.
Pre-op assessment
If surgery is an option, then the surgeon and their team will thoroughly assess whether you’re right for the surgery. They’ll consider your current health, any previous issues, and other external matters.
Surgery
Prior to going through the surgery, our team will ensure that you’re prepped once again. If everything is confirmed, you’ll undergo the surgery and then we’ll explain the aftercare instructions.
Aftercare
If necessary, you’ll stay in a ward for a few hours to ensure that you’re ready to go home after the surgery. However, this may depend on the surgery outcome and whether you need moderate or light assistance.
Follow-Up
You’ll come in a few weeks later and we’ll give you one final check-over to ensure that you’re on track for recovery.
Experts
We are proud to provide patients with access to a wide range of clinicians, chosen specifically for their knowledge and reputation in their area of expertise. Our experts align with our values: putting you at the centre of your care and educating you on your options at each step of the journey. We encourage you to learn more about our clinicians and how they can help you below. As always, please contact our patient services team if you require any additional information.
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Whether you pay in advance, spread the cost, or use your private medical insurance, rest assured you will be receiving exceptional care 365 days a year.
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Many of our treatments have a pay monthly option that allows you to spread the cost of your treatment over 12 months with no credit checks required.
A minimum spend of £300 does apply. We’ll take your first payment upfront and then arrange a direct debit for your monthly payments thereafter. It’s that simple.
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Please bring along your policy details including your scheme details, membership or policy number, expiry date and confirmation of eligibility to claim (i.e. your authorisation number). If you do not have these details with you, we will require payment from you on the day. Patients are liable for any amounts not settled by their insurer.
Hospital fee guide price: £6,230
Procedure price subject to bespoke quotation
*Additional consultant fee not included