1. 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.
2. 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.
Avoid further twisting injuries
Avoid muscle wasting by doing isometric exercises, static cycling, cross trainer and half squats.
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.
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).
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.
When ACL reconstruction is performed along with microfracture or meniscus repair please follow the specific rehabilitation programme from your surgeon.
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.