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Why might I need ACL reconstruction?
Anterior Cruciate Ligament (ACL) reconstruction is a type of knee surgery to restore the functional integrity of the torn ACL.
ACL damage usually happens to people who play sports but can happen from simple and innocuous twists. You will be recommended for an ACL reconstruction if your knee gives way in activities you wish to pursue ranging from normal day to day activities to extreme sports.
ACL reconstruction aims to allow you to return to a previous sport and/or a physical job, but the outcomes are determined by the presence or absence of other injuries at the same time to the meniscus or more importantly the soft articular cartilage. In the absence of these other injuries, outcomes are excellent and allow even professional sportspeople back to the highest levels of competitive sport.
What are the risks with an ACL reconstruction?
Other than general surgery risks (such as numbness, pain, bleeding or infection), the main ACL complications could include:
- Graft stretch or elongation
- Permanent stiffness in the knee
If the knee has any signs of early arthritis, then there is a danger that stabilising the joint by reconstruction can make it painful, giving the patient who had a painless unstable knee, a painful stable knee. For this reason, the surgeon makes a formal evaluation of the joint with the scan and an arthroscopy prior to embarking on the surgical reconstruction.
How to prepare for ACL reconstruction surgery
Preparation varies from person to person, but your operation will likely take place anywhere from 3 -6 weeks after the injury. If you are a smoker, you will be asked to stop as it increases risk of getting a chest/wound infection. Your doctor will also ask you to undergo some physio exercise to ensure you strengthen the surrounding muscles and restore your full range of motion. You may be under general anaesthetic for your procedure, in which case you will be given dietary restriction information prior to the surgery.
What will happen during my surgery?
After you have anaesthetic, your surgeon will examine your knee to check how bad the damage to your ligament is. The surgeon will examine the other knee ligaments to see if there is any additional damage. Two to four incisions will be made around the knee, with an arthroscope inserted which has a small telescope and a light inside to provide images to the surgeon. A new graft will be inserted via bone tunnels providing stability to the knee. The graft is secure using a variety of techniques that can involve screws or suspensory devices. The operation will last between 1 and 3 hours.
What happens after surgery?
The operation is a day case which means you will be able to go home on the same day. You will have dressings on the wounds, and your doctor will inform you when to take them off. You should be able to go to work soon after the surgery if you have an office job but shouldn’t expect to go back to a physical labour job straight away. You may need crutches after your doctor will advise you on how best to manage any pain. Your journey with us doesn’t end after surgery, however. The graft that is inserted by the surgeon acts as a scaffold into which new healthy cells grow. For this reason, the graft does initially get weaker before it gets stronger again. Some surgeons will advocate the use of a brace routinely after surgery, others do not use a brace. Return to pre-injury activity is slow and even in professional sportspeople is rarely before 9 months after the surgery and completion of a rigorous post-operative physiotherapy regime.