The human knee is a complex network of bones, cartilage, ligaments, tendons, and muscles. The anterior cruciate ligament (ACL) plays a vital role in maintaining stability and enabling movements such as pivoting and twisting.
When the ACL is injured, ACL reconstruction surgery may be necessary for those who want to restore knee function for sports and prevent chronic, long-term pain.
If you have an ACL injury and want to understand your recovery path, read on to understand if this surgery may be for you. At Alps Orthopaedic Centre, our Orthopaedic Surgeon is dedicated to providing patients with an optimal treatment and recovery plan, helping you fully recover and regain the use of this critical joint.
What is ACL reconstruction surgery?
The ACL refers to a strong band of tissues in the knee joint that stabilises the knee. An injury to the ACL means that the ligament could either be stretched or torn beyond its natural limit due to a sudden twisting motion. This often occurs among athletes during sports accidents or high-impact activities, such as falls or jumps. In some cases, you may even hear a popping sound at the time of injury, along with severe pain and instability of the knee.
Depending on the extent of your injury, you may or may not require surgical treatment. ACL reconstruction surgery is primarily indicated for individuals with complete ACL tears / high-grade partial tear, significant knee instability affecting their lifestyle, and those who do not respond to conservative treatment methods. The decision for surgery should consider the patient’s activity level, age, and specific clinical findings related to the injury.
ACL Reconstruction Surgery is a minimally invasive procedure that reconstructs a damaged ACL using graft material, typically from the patient’s body (autograft) or a donor (allograft). Using this minimally invasive technique, your orthopaedic surgeon can operate with smaller incisions, reduced pain, and a faster recovery than conventional surgery.
By opting for reconstruction surgery, you are reconstructing your damaged ACL with new tissue that acts as the ligament, restoring knee function. That said, patients will have to commit to post-surgery rehabilitation to ensure optimal knee recovery.
Who should get ACL reconstruction surgery?
You may wonder whether ACL reconstruction surgery is necessary for everyone who has injured their ACL. The fact is, surgery is not always required. Patients with an injured ACL can still walk in a straight line. However, you may face instability and pain when doing certain movements like turning, twisting or pivoting on the knee.
In the long run, you may also increase your chances of developing certain injuries or conditions like meniscus injury and knee osteoarthritis.
Hence, it is crucial for you to consult a proper orthopaedic specialist to help you understand if this procedure is necessary. When deciding if the procedure is right for you, consider the following:
- What is the extent of your ACL damage?
- Is your ACL injury preventing you from performing certain activities that you love?
- How active are you in your daily life?
- Will the surgery solve your main concern?
- What is the risk of developing another knee injury without surgery?
It is important to note that a completely torn ACL cannot heal on its own. In that case, you may need a surgical treatment to regain optimal use of your knee. For athletes and those who lead an active lifestyle, the surgery may be necessary if you wish to return to your previous level of activity. In cases of low-grade partial tears, there may be a chance to achieve full recovery with non-surgical treatments, including physiotherapy.
For a more robust decision-making process, consult an orthopaedic specialist who can accurately assess your condition and recommend an appropriate treatment plan.
Benefits
While an ACL reconstruction surgery is minimally invasive in nature and thereby encourages a speedier recovery, opting for the surgery would still typically require patients to commit to a 9-month rehabilitation process before regaining full function of the knee joint for active sports.
Nevertheless, the long-term benefits it provides for some individuals can be significant, such as:
- Enhancing Joint Stability: The ACL does not have the ability to regenerate itself. Hence, a reconstructive surgery is the only way for patients with a fully torn / high-grade partially torn ACL to regain the stability their joints had before the injury.
- Resuming Sports and Activities: For athletes and active individuals, returning to sports or other physically demanding activities may be difficult without surgical intervention to correct the torn ACL.
- Lowering the Risk of Additional Knee Injuries: Untreated ACL injuries can result in persistent instability, which increases the likelihood of further damage to other parts of the knee, including meniscus and cartilage injuries.
- Mitigating Chronic Knee Conditions: An ACL injury can predispose the knee to long-term conditions like osteoarthritis, which gradually deteriorates the joint’s cushioning, resulting in stiffness and limited mobility.
Whether you opt for ACL reconstruction will depend largely on your specific needs and knee condition, as advised by an orthopaedic specialist.
Risks
Similar to most surgeries, an ACL reconstruction does carry small risks. However, ACL reconstruction surgery is largely successful in most patients and side effects are likely manageable with appropriate measures in place. Some commonly seen side effects in patients may include:
- Pain around the kneecap after surgery which can be managed with physical therapy.
- Stiffness which can be avoided with rehabilitation exercises soon after surgery.
Understanding the benefits and risks is crucial in determining if ACL surgery is right for you. Make an informed decision by consulting a reliable orthopaedic specialist.
How to prepare for the surgery?
Before your surgery, you will need to consult an orthopaedic surgeon to determine if you are fit for the procedure. During this stage, your surgeon will advise you on preparations, such as:
- Stopping any blood thinner medications, if required
- Attending physical therapy to improve range of motion before your surgery
- Quitting smoking and alcohol consumption, which may impact the healing process post-surgery
As most ACL reconstruction surgeries are carried out as day surgeries, you should also plan your mode of transportation for returning home after the procedure and consider wearing loose-fitting clothes for comfort during your return.
What happens during surgery?
During the start of the surgery, patients will be placed under general anaesthesia. Once the anaesthesia is in effect, your surgeon will proceed to operate with the following steps:
- Knee examination: A small incision is made in the knee area where a thin camera instrument (arthroscope) is inserted to visualise the inside structure.
- Removal of Damaged ACL: Your surgeon will identify the torn ACL and remove it as needed.
- Graft Harvesting: The graft used to replace the torn ACL can be taken from the patient’s own body (autograft) or from a donor (allograft). Common sources for autografts include the hamstring tendons or the quads tendon.
- Creating Bone Tunnels: Bone tunnels are drilled into the femur (thigh bone) and tibia (shin bone) to allow for secure placement of the graft. The graft is then threaded through these tunnels, mimicking the natural position of the original ACL.
- Fixation of the Graft: Your surgeon will then fix the graft tissue to the thigh bone (femur) and shin bone (tibia). The graft will be kept in place with either screws or other fixation devices, such as endobutton.
- Closing Incisions: The incision will then be closed up at the end of the procedure.
The entire procedure may take 1 to 1.5 hours to complete. Once done, your care team will continue to monitor your condition before determining if you are safe to return home.
However, depending on each patient’s condition, some may require an overnight stay for monitoring.
Recovery and care
Recovery from ACL surgery will be a gradual process. Most patients can start walking unassisted within 2 to 4 weeks but would generally require 6–9 months to resume physically demanding activities like sports.
For a smoother recovery process, you are recommended to do the following:
- Ensure you attend physical therapy to rebuild the muscle strength and flexibility to restore full use of your knee joint.
- Opt for a well-balanced diet that promotes healing and refrain from consumption of alcohol or smoking that could hinder the body’s recovery process.
- Make sure to follow your surgeon’s instructions on postoperative care which includes wound management, medication and activity restrictions to avoid unwanted complications.
Immediate Recovery: Patients are generally able to walk with crutches and a knee brace on the same day as surgery. Elevation and ice application are recommended to manage swelling and discomfort.
Rehabilitation Timeline: Rehabilitation begins within a few days post-surgery, focusing on restoring strength, stability and range of motion in the knee.
A typical recovery timeline after surgery includes:
1st to 6th weeks: Wearing a knee brace with a gradual increase in knee range of motion and mobility. Wean off crutches by 2 to 4 weeks. Beginning of strengthening exercises.
7th to 12th weeks: Wean off knee brace. Straight line exercises and progressive strengthening exercises. Emphasis on regaining full range of motion and beginning strengthening exercises.
4th to 6th months: Progression to more intense rehabilitation activities. Field training, including jumping and single-leg hopping.
7th to 9th months: Sports-specific rehabilitation (including soccer, basketball, skiing). Return to sports after approximately 9 months.
Long-term Outlook: Full recovery can take anywhere from six months to a year, depending on individual factors such as age, activity level, and adherence to rehabilitation protocols. Regular follow-ups with healthcare providers are crucial during this period to monitor progress and adjust rehabilitation plans as needed.
Get ACL reconstruction surgery in Singapore
At Alps Orthopaedic Centre, we understand our patients’ determination to regain the mobility they need to fit their lifestyles. Our Senior Consultant Orthopaedic Surgeon, Dr Jerry Chen, is dedicated to helping patients achieve this through minimally invasive treatments that promote less pain and optimal recovery.
For a detailed assessment, treatment, and recovery plan, schedule an appointment with Dr Jerry Chen today at Alps Orthopaedic Centre.
