Daycase Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction

The ACL is one of the main ligaments in the knee which runs through the centre of the knee from the back of the femur (thigh bone) to the front of the tibia (shin bone). It acts as a link mechanism to stabilise the knee, especially in twisting movements.

If the ACL has been torn, patients often complain of the knee giving way or feeling unstable. This operation gives you a new ligament which will stabilise the knee and help you to return to work and sport.

It is known from research studies that up to 90% of patients consider their knee to function normally or near normally after this operation. Some patients will also have damaged one of the menisci (cartilages) inside the knee. This will be treated at the same operation. It can take 9 - 12 months of rehabilitation after your operation for you to recover fully. It is essential that the physiotherapy rehabilitation program is completed and not cut short, to reduce the chance of rupturing the ACL reconstruction (graft) and to improve the chance for you returning to pre-injury activity level.

Most ACL reconstructions will be done as a daycase operation. This means that usually you will go home on the same day as your operation.

Most of the operation is done using keyhole surgery. Your surgeon will make a number of small skin incisions (cuts) around your knee and the operation is done through these.

Firstly, part of the hamstring tendons are taken from the inner part of the knee and these are used to replace the torn ACL. Alternatively the new ligament is made from a small piece of the kneecap (patella) and its tendon (patellar tendon). Your surgeon will discuss with you the benefits of each so you are able to decide the best option for you.

The rest of the operation is done from inside the knee. A hole (tunnel) is drilled into the femur (thigh bone) and tibia (shin bone) and the new ligament is passed through the middle of the knee into these holes and is fixed in place.

If you have a tear of a meniscus (cartilage) then this will be tidied up or repaired at the same operation. The small skin incisions (cuts) are closed with stitches and a well padded bandage is put on to cover the knee.

All operations have risks, but these thankfully are small with this operation. Your surgeon will discuss these with you before surgery.

Wound infection (1-2%)

This is treated with antibiotics.

Swelling

Your knee will be swollen after the operation and this may take several months to settle.

Stiffness

This can be helped with physiotherapy. 

Knee instability (10%)

Some people find that they cannot return to full sporting activities after surgery.

Skin numbness

You may have skin numbness around the front of the knee and down the shin. This usually resolves within 18 months.

Deep vein thrombosis (DVT) (1-2%)

Blood clots can occur with any operation but are rare with this operation. You will be walking on the same day as the operation and this reduces the risk of blood clots.

Re-rupture of the new ligament (5-7%)

If you have another injury you may damage the new ligament. Strengthening the knee with physiotherapy after the operation helps prevent this.

You will be seen by a nurse who will ask you questions about your health and any medication you are taking. This helps check that you are ready to have an operation. For you to go home on the day of the operation you must not have any significant medical problems, have a responsible adult to take you home by car and stay with you for 24 hours after the operation. If there are any concerns about your health you may be asked to see an anaesthetist for an assessment before you are given a date for surgery.

Your anaesthetist will see you on the day of surgery and discuss and explain the anaesthetic options. There are two main options:

1. General Anaesthetic: This means the operation will be done while you are asleep.
2. Spinal Anaesthetic: This means the operation will be done while you are awake. A local anaesthetic drug is injected through a needle into the small of your back to numb the nerves from the waist down to the toes. Depending on the type of local anaesthetic the numbness will last for 2-4 hours.

You may be offered a saphenous nerve block in addition to your general or spinal anaesthetic for your pain relief after your operation. This is an injection at inside of your thigh to numb the main sensory nerve to your knee.

You will be seen by your surgeon again after pre-assessment and before the operation. The details of the operation will be discussed and you will be able to ask any questions you may have before signing the consent form.

The hospital will send you a letter before your operation with details of what time to arrive and where to go on the day of your operation.

Please follow the starvation instructions given to you at Pre-assessment or in the You and Your Anaesthetic information.

Your surgeon will see you on the day of surgery and check that you are ready. You can also ask any other questions about your operation which your surgeon will answer.

You will be seen by your anaesthetist to discuss your health and anaesthetic.

A physiotherapist will also see you before your operation. You will be shown how to use crutches in case you need them, and given general advice on how to look after your knee following your operation to help the swelling go down.

You will be taken to the Recovery ward from the operating theatre where a nurse will stay with you. You will be given strong painkillers if you need them. A special cuff may be wrapped around your knee that contains ice to help the swelling settle.

When you are back on the ward you will usually be given a light snack and a drink. You may also be given further advice from your physiotherapist on some exercises to do at home and the use of ice.

The nurses will telephone the person collecting you when you are ready to leave. You will be given some painkillers to take at home as well as details of your physiotherapy appointment and clinic appointment.

You should rest and follow the instructions given to you by the physiotherapist to help reduce the swelling and gently start moving your knee again. You can put all of your weight on your knee, using the crutches to help you balance.

Getting the movement back in your knee early after your operation is very important, and you will have to do your exercises every 4 hours. Full written instructions will be given to you. The bandages stay on for up to 2 days after your operation. It is important that you drink 2 litres of water a day as this helps prevent blood clots.

After your operation the physiotherapist will help you to recover. It is very important that you follow the exercises they give you as this will help you get the most out of the new ligament. You will be seen by your physiotherapist on a regular basis.

Weeks 1-2

Regain movement in the knee, especially extension and let the swelling settle. Resting indoors for the first week is encouraged.

Weeks 2-3

You will be gradually weaned off your crutches and you will start pool and gym based exercises.

Weeks 3-12

You will progress with exercises in the pool and gym and usually around 8-12 weeks, depending on how quickly your knee recovers you will begin light jogging activities and cardiovascular work, and higher intensity training for balance and control.

Months 3-6

You will continue with strengthening exercises in the gym and progress to more high intensity sport specific training e.g. running, cutting, accelerating, decelerating and turning activities under the close supervision of your physiotherapist.

Month 6 onwards

You will progress to the final stages of your rehabilitation which will include sport specific drills. This is in preparation for your return to sport.

Months 9-12

Full return to sport, but sometimes longer. Your surgeon and physiotherapist will tell you when it is safe for you to return to sport.

You can usually start driving after 6 weeks. Your surgeon and physiotherapist will confirm when you are safe to drive.

Recent studies have shown that the incidence of ACL injury can be reduced by up to 70% with the use of a specific warm up program before training.

The PEP program (Prevent injury and Enhance Performance program) was developed in Santa Monica by the Santa Monica Orthopaedic Sports Medicine Research Foundation. The program has 5 highly specific parts designed to improve neuromuscular conditioning and muscle reactions which decrease ACL injury:

• Warm up - to prevent muscle strain
• Stretching - to lengthen muscles and prevent injury 
• Strengthening - to support the body to prevent injury
• Plyometrics - exercises involving jumping, concentrating on landing correctly
• Agilities - including shuttle runs and diagonal runs

Additional details can be found on the Santa Monica Orthopaedic and Sports Medicine Research Foundation website.

Day Surgery 

01709 426500

Mr AJ Anderson’s Secretary

01709 425302

Mr AJ Legg’s Secretary

01709 425302

Park Rehab Centre

01709 302323