ACL reconstruction

ACL reconstruction is when a piece of tissue from a tendon is used to replace a torn tendon. It is fixed to the bone with biodegradable screws and does not normally need further surgery in the future. (If tissue is taken from you, it is called an autograft; if donated by another person it is known as an allograft.)

Surgery is carried out using arthroscopy to remove or repair the tissues and correct any problems.

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

Are there any risks?

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. If you are worried, contact the Fortius Clinic for advice
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%).

ACL post-operative rehabilitation

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.

How long does it take to get back to normal?

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

Phase 1 – Early (approximately 6-8 weeks)
Goals (to be achieved by the end of this phase):
• Minimal pain
• Minimal swelling in the knee
• Full movement of the knee, especially straightening the knee out
• A normal walking pattern without a limp both on flat ground and on the stairs
• Starting to regain good strength in the operated leg and good ‘core control’
• Equal balance when standing on one leg with eyes open/eyes closed

Phase 2 – Middle (approximately 3-4 months)
Goals (to be achieved by the end of this phase):
• No pain
• No swelling
• 80% strength in the muscles of the operated leg when compared with the other leg
• Good ‘core control’
• Good single leg squat strength and control
• Good basic hopping and landing skills
• Being able to start jogging with an even running style and without a limp (only to be attempted when strength is good and under the guidance of your physiotherapist)

Phase 3 – Late (approximately 6-9 months or more)
Goals (to be achieved by the end of this phase):
• No pain
• No swelling
• At least 90% strength in the muscles of the operated leg when compared with the other leg
• A good level of general fitness
• Good agility and coordination in preparation for a return to sport
• Be confident and mentally prepared for a return to sport


When can I start to drive again?

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.

When can I return to work?

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.

When can I return to sports?

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.
Activities that place acceptable levels of strain on your knee joint (and are therefore recommended following surgery) include walking, cycling, swimming, golf, bowling, rowing, and hiking
Activities that place too much strain on your knee joint and are therefore not recommended following surgery include jogging, squash, football, rugby, downhill skiing and hocke

Will the metal in my knee set off a metal detector?

Smaller screws used to fix an ACL reconstruction may or may not set off the alarms so it is best to be prepared. It is advisable to have some written evidence of your surgery, in addition to your scar! If you are travelling abroad, please contact the Fortius Clinic at least two weeks before you travel so we can prepare a letter for you.