Please note that a referral letter is required before an appointment can be confirmed.
About this service
The anterior cruciate ligament (ACL) is one of the most important ligaments in the knee. It prevents excessive forward movement of the tibia relative to the femur and also controls rotation of these two bones.
However, the ligament can be relatively easily injured particularly during sports activities, and this injury can be very painful. Often your knee will become very swollen and the movement will be restricted.
Whether you need surgery or not will depend on the outcome of your scan, which will inform the diagnosis. There are three types or grades of injury.
- Grade I sprain: some stretching and micro-tearing of the ligament, but the ligament is intact and the joint remains stable. These injuries rarely require surgery.
- Grade II sprain (partial disruption): some tearing of the ligament. The ligament is partially disrupted and the joint is moderately unstable. Depending on the patient and the degree of instability, these tears may or may not require surgery.
- Grade III sprain (complete disruption): total rupture of the ligament causing the joint to be unstable. Surgery is usually recommended in young or athletic persons who engage in cutting or pivoting sports.
A completely torn ACL will never heal back to its pre-injury state even following rehabilitation and physiotherapy. In addition, even with a partially torn ligament, the normal mechanics of motion of the knee may be altered.
ACL injuries can be accompanied by other injuries such as:
- Meniscus tear: menisci are “cushions” between the tibia and femur that act as a shock absorber. A meniscus tear typically occurs with twisting motions.
- Media collateral ligament (MCL) tear: the medial collateral ligament provides stability on the inside of the knee. Injury to the MCL is quite common, but if it is an isolated injury it can usually be treated with physiotherapy and bracing.
The diagnosis of ACL injuries can usually be accurately diagnosed by clinical examination of the knee. If necessary an MRI can be used to diagnose the condition.
There are two different grafts used when repairing the ACL.
The first is the hamstring tendon autograft where one of the five hamstring tendons which help to flex the knee is used to reconstruct the ACL.
The other is the patellar tendon autograft where the middle third of the patellar ligament that runs from the bottom of the kneecap (patella) to the front of the tibia is used along with bone blocks from the patella and the tibia. Your consultant will discuss your options and their impact with you in advance of surgery.
The operation takes between one and two hours to complete. After the procedure, you will normally spend one to two hours in the recovery room and usually can be discharged on the same day.
You will be given pain medication to help with the pain and swelling from the surgery. You will also be provided with a prescription for pain medication before you are discharged.
During recovery which can take a few months, your knee must be protected with a postoperative brace to prevent overuse or stressing of the area while the knee heals.
You will also be required to follow a strict rehabilitation program in order to ensure that your knee heals correctly. Please note that many patients will feel comfortable long before healing has finished and strict adherence to the postoperative activity restrictions is essential.
ACL reconstruction is usually very effective and as long as the knee is cared for properly and subsequent traumatic injuries are avoided, the benefits of the surgery should be permanent.
In general, patients are able to perform gentle activities of daily living starting two or three weeks after surgery. Most people who work at a desk job can return to work during this time. The patient is strongly encouraged to continue wearing the functional knee brace.