ACL Repair

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:

1. Strengthening Muscles: Focuses on quadriceps and hamstrings to stabilise the knee joint, reducing strain on the injured ACL and correcting muscle imbalances.
2. Improving Range of Motion: Maintains knee flexibility to prevent stiffness post-surgery, making rehabilitation easier.
3. Reducing Swelling: Involves techniques to minimise swelling and inflammation, aiding faster recovery and reducing pain.
4. Optimising Recovery: Facilitates a quicker recovery by ensuring stronger muscles and better joint condition, enhancing post-surgery rehab.
5. Minimising Complications: Reduces the risk of post-operative stiffness, weakness, or instability by strengthening muscles and teaching proper movement patterns.

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.

Recovery and rehabilitation are crucial components of ACL reconstruction surgery. The rehabilitation process typically involves several phases:

1. 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.
2. 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.
3. 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.
4. 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.