What is Anterior Cruciate Ligament Reconstruction?
The anterior cruciate ligament (ACL) is one of the two large
ligaments within the knee. It controls front to back and,
most importantly, pivoting or twisting movement. The ACL can
be torn or ruptured during sports activities and once broken, it
rarely heals and the knee may give way.
Regular giving way can leads to secondary damage to the menisci
(Shock absorbers) and articular cartilage (joint surface) as well
as making twisting and turning difficult.
A ligament graft is required using material taken from the front
of the knee or from the hamstring tendons behind the knee, both of
which are able to re-grow to a large extent.
Successful ACL reconstruction will mean your knee will no longer
give way and you can return to sports activities.
What does this involve?
Anterior cruciate ligament reconstruction is usually performed
through keyhole surgery under general anaesthetic. You would
normally be admitted on the day of the operation and some people go
home the same day or have an overnight stay in hospital.
You will not be able to eat for eight hours prior to surgery
although you will be able to drink small amounts of water up to
four hours before.
The operation takes about one hour and your Surgeon will make
some incisions in your knee to allow small specially designed
instruments to be introduced. The torn ligaments are trimmed
and the knee is prepared for the replacement graft of suitable
tissue from somewhere else on your body. Part of the patellar
tendon (which runs from the lower end of your kneecap to the
top of your shin bone) is normally used. The top
and bottom ends of the replacement ligament are fixed into place
with special screws into holes drilled into your bones.
The incisions are closed with stitches or adhesive strips
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When will I recover?
Recovery from the anaesthetic is rapid and you will be awake
very soon after the operation although you may feel drowsy for an
hour or two. You will be allowed to go home once you are
weight bearing with the assistance of crutches, if necessary, for
security. You will usually have an X ray to check that the
ligament graft is in the correct position.
You may shower with the waterproof dressing on and your
Physiotherapists will give you advice on how to exercise your leg
before you leave and may arrange outpatient physiotherapy if
needed. You will be given a cold compress or 'Cryocuff' along
with instructions on how to cool your knee, which is important and
aids recovery. You will see your Consultant once again two
weeks after your operation to review your progress.
You may need to take 4-6 weeks off work and driving following
the operation and your Surgeon may want you to ear a knee brace for
a few weeks.
Once your knee has settled down, you will need to start
intensive physiotherapy which may continue as long as six
months.
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What risks should I know about?
Anterior cruciate ligament reconstruction is commonly performed
and generally safe but there are some potential complications you
should be aware of. These only affect less than 4% of
patients.
- Infection can occur although our theatres have ultra-clean air
operating conditions keeping infection rates at 1-2%.
- Blood clots are possible but again are in the 1-4% category and
have well established treatments including aspirin.
- Damage to the nerves around the knee leading to weakness,
numbness or pain in the leg or foot - this usually settles on its
own. Risk is less than 1%.
- A break of the kneecap can occur during or after surgery but
only if your surgeon uses a patella tendon graft - 1%
risk.
- The knee keeps giving way. This may happen if the
ligament graft fails due to stretching or a further injury. Risk
less than 10%
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Circle care
Knee surgery is carried out in our Knee Unit at CircleBath where
specialist knee surgeons have created a centre of excellence.
You can be sure of state of the art facilities and the best
possible care to get you back to normal as soon as possible.
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