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+44 1733 592975 (Only For Fitzwilliam Patients)
An ACL injury most commonly occurs during sports that involve twisting or overextending of your knee. An ACL can be injured in several ways:
• Sudden directional change
• Slowing down while running
• Landing incorrectly from a jump
• Direct blow to the side of your knee, such as during a football tackle
When you injure your ACL, you might hear a loud "pop" sound (30%) and may feel the knee buckle. Within a few hours after an ACL injury, your knee may swell due to bleeding from vessels within the torn ligament. Afterwards you may notice that the knee feels unstable or seems to give way, especially when trying to change direction on the knee.
An ACL injury can be diagnosed with a thorough physical examination of the knee and diagnostic tests such as an MRI scan. X-rays may be needed to rule out any fractures.
It is not possible to repair a torn ACL by stitching it back together. However, it can be reconstructed by using grafts to replicate the function of the damaged ligament.
The anterior cruciate ligament (ACL) is the commonest ligament in the knee that needs to be reconstructed. There are two ways to reconstruct this ligament; one is to use the hamstring tendons (semitendinosus and gracilis tendons) (tendons are similar to ligaments, except that tendons attach muscles to bones); the other is to use the central third of the patellar (knee cap) tendon.
For the majority of cases, Mr Subramanian uses hamstring grafts since the cuts required to perform this surgery are significantly smaller than using the central third of the patella tendon. A small cut of 3-4cms cut is made over the upper leg to remove the hamstring grafts.
The majority of ACL reconstruction surgery is performed using arthroscopy so that the knee joint does not have to be opened. This speeds recovery and significantly reduces the amount of post-operative pain.
The procedure involves removing the ruptured ligament and placing the hamstring graft in the correct position to allow it to reproduce anterior cruciate ligament function.
After surgery you will need crutches and a brace to keep the knee straight and avoid further injury. You will be offered painkillers to enable you to sleep comfortably and begin exercising your knee effectively The knee may be swollen and bruised, so you should keep your leg elevated (raised) when not walking or exercising and you can also use ice to reduce the swelling.The best method is to wrap some crushed ice or frozen peas in a towel and place onto the swollen area for around 20 minutes, four times a day, until the swelling goes down
Complications following ACL reconstruction surgery are rare. However, they can include:
Infection
The chance of infection is less than 1% and can usually be treated effectively with antibiotics. Usually only the skin is affected, but if bacteria get into the knee itself then it may be necessary to have a further operation to wash it out with saline solution and give stronger antibiotics via a drip.
Deep vein thrombosis (DVT)
The risk of this is less than 1% and is unusual if you move around as much as possible after surgery. Symptoms include pain, swelling, warmth and redness of the calf. Less commonly, a DVT can also present in the thigh area
Swelling
Swelling and bruising around the knee joint is common after ACL reconstruction surgery. The swelling may feel tight and a little uncomfortable
Stiffness
Most people experience some stiffness in the joint after an operation, but this should improve with exercise and physiotherapy
Nerve damage Small nerves that supply sensation to the skin near the operation site can be damaged, although the risk of this is small (less than 2%).
Everyone is different, so healing and post-operative programmes vary from person to person. Each patient will be assessed and treated according to his or her own progress after surgery. The ward physiotherapist will give you some simple exercises while you are still in hospital to help with your recovery. The exercises aim to get your knee comfortably moving again, strengthen your muscles and aid your circulation.
Once you are able to walk comfortably and safely, both on flat ground and on the stairs, and you have a satisfactory range of movement in your knee, you will be ready to return home
The time it takes to recover following ACL reconstruction surgery varies from one person to the next. There are many factors that determine the rate of recovery following surgery and how soon someone returns to physical work or their usual sporting activities
Before your operation it is important that you take steps to ensure you keep your body weight controlled and your fitness and strength levels good. This will help to improve your chances of a speedy recovery and lower your risk of complications after surgery
One of the biggest factors that will determine the rate of recovery and long-term outcome following surgery is your motivation and adherence to a rehabilitation programme
The DVLA states that it is the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is if you can stamp down hard with the foot to stop the car during an emergency stop. It will take at least two weeks but it may be up to four weeks, your consultant will advise you on this. You should also check with your vehicle insurer to confirm you are covered.
This depends on the type of work you do and how quickly you recover. As a general guide, if your job involves sitting down for most of the time, you should be able to return to work between 1-2 weeks; if it involves manual work, you may need to take three or four months off. If you aren’t certain, ask your surgeon for advice.
Your surgeon will be able to advise you about this but it is usually safe to return to most activities once you have adequate flexibility, strength and fitness