What is an ACL reconstruction?
When the anterior cruciate ligament (ACL) ruptures and causes instability in the knee, you may be offered surgery. The ACL cannot be directly repaired, and so a “graft” has to be taken and inserted in the place of the ruptured ligament. In the UK, the two most common grafts are the patellar tendon (below the kneecap) and the hamstring tendons. The surgery may be repaired via open or arthroscopic techniques. We favour an arthroscopic hamstring ACL reconstruction.
Why is it performed?
An ACL reconstruction is performed if the knee is giving way after rupture of the ligament, and a course of physiotherapy has failed.
What does the operation involve?
The operation is done under general anaesthetic with a one or two-night stay. The hamstring tendons are “harvested” through a small incision below the knee, then the graft is passed through “tunnels” made in the femur and tibia, and fixed at either end.
What about pain?
Whilst you are in hospital you will be monitored and the medical staff will give you painkillers as required and prescribed. When you are at home you may find Paracetamol or Ibuprofen useful for controlling any pain. Instructions on management of pain will be given by the nursing staff before you leave the hospital.
How long does recovery take?
You should expect considerable swelling in the knee and lower leg for the first few weeks. A “cryocuff” (iced bandage) is used whilst in hospital, which helps to minimise this. We do not use braces, and you will encouraged to walk the day after surgery. It is important to appreciate that the physiotherapy after an ACL reconstruction is as important as the surgery.
Your wound dressing will be changed and stitches removed (if applicable) at the clinic during your follow up appointment, which is usually 7-10 days after the operation.
With the guidance of the physiotherapist, you will enter a stepwise period of rehabilitation. The emphasis in the first few weeks is in clearing the swelling and recovering range of movement. Around six weeks, you will begin working on regaining lost muscle strength. Gentle running on a treadmill may begin around 3 months, and formal straight-line running around six months. Sports such as football are possible at 9 months, but skiing is best left for 12 months.
Swimming will be possible once the sutures are removed and the wound is healing satisfactorily. You are advised not to fly after surgery for about 6 weeks.
When can I go back to work?
This will depend on the type of work you do. For example if you have a desk job you should be able to return to work after 2 weeks and most people are back at work by 6 weeks. If on the other hand you do manual work where there would be a lot of pressure on the knee then you may need up to 3 months off work.
What can go wrong? All operative interventions have an inbuilt risk and complication rate. The risks following arthroscopy to the ankle are as follows:
- Infection (the wound may become infected and inflamed).
- Bleeding into the joint.
- Arthrofibrosis (stiffness of the knee).
- Injury to a nerve resulting in numbness over the shin.
- Deep vein thrombosis (clot in a vein).
- Pulmonary embolus (clot in the lungs).
- Persistent effusion (swelling).
- Prominent metalwork requiring removal.
- Persistent instability.
- Re-rupture of the ligament.
- RSD.
- Arthritis.
The above complications are rare but can occur.
