- Modify activities and not have surgery-By adequate training of muscles and balance around the knee and modifying activities, some patients may not have giving way. If the gives way after such a programme, then go for surgery.
- Surgery- This is performed to treat instability. Should one be keen on twisting activities as is common in sports like football, rugby and racquet sports, then instability is predicted. ACL reconstruction is recommended early to prevent meniscal damage.
- Regain full movements and reduce pain and swelling
- Avoid further twisting injuries
- Avoid muscle wasting by doing isometric exercises, static cycling, cross trainer and half squats.
The operation is usually done as day-case. Your surgeon and the physiotherapists will see you on the morning of the surgery and this gives another opportunity to ask any questions.
The operation is performed usually under General Anaesthesia and takes about an hour. When you are asleep, the anaesthetist might inject a local anaesthetic agent around the nerve in your thigh to numb the leg and your surgeon might also inject painkillers around the knee during the operation.
Your surgeon then carefully examines your knee to further establish ACL deficiency. Most of the surgery is performed via two keyholes, but you would have a 2-4cm scar (see picture) through which your own tendon would be harvested. Any meniscus or articular cartilage surgery is done simultaneously through the keyhole. The ruptured ACL is removed using a shaver and replaced using the tendon harvested. The new graft is fixed with special buttons and/or screws. Back to Questions
You would be in a recovery ward until your anaesthetic wears away. Don’t be surprised to notice numbness in your thigh and leg as this may be due to nerve block providing pain relief. You would have a bulky bandage. Knee braces may be used if there has been a simultaneous meniscus repair. Some centres may routinely use a knee brace and a Continuous Passive Mobilisation (CPM) machine.
Your surgeon would visit you, show you pictures of your knee and explain about your operation and any changes to your early rehabilitation. You would have a post-operative check x-ray of your knee. The physiotherapists would then advice early rehabilitation to regain knee movements. You are likely to mobilise with the aid of crutches and then go home. An outpatient appointment would be made for physiotherapy within a week. The simplest exercises to do after you get home are quadriceps bracing and heel slides (See rehabilitation page). Back to Questions
The bulky dressing can be taken down in 24-48 hours and the simple adherent light dressings left behind or replaced. You may notice sticky tapes that have been used to seal your arthroscopy portals. Don’t worry if these tapes come off. Keep the knee dry for 10 days until the wounds heal. If you shower the knee, blot it dry.
You may notice bruising or discoloration at the back of thigh or leg. This can be from bleeding from hamstring harvest. Intermittent icing or use of cryocuff with compression is beneficial. Don’t leave ice on the skin for longer than 15-20 minutes at a time. Back to Questions
For the right knee stay off driving for of 4 weeks and for the left knee at least 3 weeks (UK). This also depends on range of motion and ability to do an emergency stop. Make sure that you inform your insurer.
When ACL reconstruction is performed along with microfracture or meniscus repair please follow the specific rehabilitation programme from your surgeon. Back to Questions
- have pain, swelling or tenderness in the joint which is getting worse,
- develop a high temperature,
- see fluid, pus or blood coming from the incisions, or
- develop numbness or tingling near to the joint
- Contact your hospital ward nurse or your physiotherapist who would liaise with your Surgeon. If it is at late hours in the night, you may have to attend the emergency department and see the on call Orthopaedic Doctor who would assess your knee and speak to your surgeon. Back to Questions
Normal ACL
Ruptured ACL
Hamstrings acl graft
 
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Please consult a specialist for advice on your condition.