In our last blog, we took a brief tour of the ACL – what this particular ligament is and, crucially, how people damage it (the most common answer is a sporting injury).
If you read that article, you’ll know the ACL is one of the knee’s great workhorses. It enables things like stability, control over backwards and forwards movement, and resistance to buckling. If you tear your ACL, it can throw all that functionality into jeopardy.
So let’s imagine you have torn your ACL. What next? One potential option is an ACL reconstruction. Here’s how this procedure works.
Who is the operation for?
Some ACL tears can heal naturally with rest and rehab; the ligament may never be the same as before, or so strong, but you won’t lose stability or range of motion in your knee. ACL reconstruction is for people who have suffered more severe damage. For example, you might be experiencing ongoing instability. Or you may have damaged other tissues alongside your ACL – a meniscus tear is quite common. Or, if you’re unlucky, your ACL may have torn completely away from the bone.
Does everyone with severe ACL damage go on to have a reconstruction?
No. It often comes down to lifestyle, and how much the injury affects your daily activities. Serious sports fans and athletes often opt for reconstruction, because the twisting, turning and pivoting they’ve lost are too crucial for them. But that’s not everyone. A middle-aged person who avoids contact sports, for instance, may prefer to focus on building up leg muscles to improve functionality. You can do a lot to help your ACL by increasing strength in the surrounding tissues.
How does a reconstruction work?
The idea is to remove the torn ACL section and replace it with a new one. This “graft” may come from elsewhere in your body, usually your hamstring, or from a donor. When you come into theatre, we’ll first take the graft, then prepare your knee for attachment. This involves making some tiny holes in your thigh bone (femur) and shinbone (tibia), before carefully positioning the graft across your joint and securing it to the holes with a suspension device and / or surgical screws. The operation can be done by keyhole surgery and usually takes 60 to 90 minutes.
Is there anything else to bear in mind?
Before surgery, you’ll likely do several weeks of preparatory physio. We call this prehabilitation (prehab). The idea is to reduce post-injury swelling and stiffness, strengthen the muscles around your knee and get as much movement into your joint as possible. Prehab gets your knee into the best shape for reconstruction; it can make a big difference to the range of motion you’re able to achieve from your graft and to your recovery after surgery.
What’s the recovery period like?
It varies from patient to patient, but most people can put their full weight on the knee almost immediately and regain full movement within six to eight weeks. As our ACL case study patient Beth points out, the early stage is undoubtedly the hardest. “For the first couple of days you’re supposed to keep standing to a minimum because of the swelling,” she explains. “You have to try to keep your leg raised, and keep icing the knee three or four times a day. You also start the physiotherapy as soon as you get home. They give you a leaflet with exercises to do, like putting your foot on something that has been raised off the floor, then letting the knee drop down with gravity. You’re supposed to do strengthening exercises every hour.” Although the strengthening can feel uncomfortable at first, it will help the overall restoration process. “If you can grit your teeth for those first two weeks, it pays off in the long run,” Beth adds.
Interested in finding out more? You might find these articles helpful
Mythbuster: 6 big misconceptions about ACL injuries
ACL page in our Knee Treatments section (click the ACL Reconstruction dropdown)
Case study with Robb, who had ACL reconstruction after a football injury
Have you recently injured your ACL, or suffered other damage or instability to your knee? We can help you find out what’s going on. Drop us a line, or book an appointment directly on the website, and we’ll help you get the right diagnosis and treatment plan for your knee.