Navigating ACL reconstruction: From surgery to return to sports

ACL reconstruction is a surgical procedure to repair a torn ACL (anterior cruciate ligament) in the knee, which is crucial for stabilising the knee during rotational movements.

Here, Mr Breck Lord, renowned consultant orthopaedic hip and knee surgeon, offers an expert insight into ACL reconstruction surgery. 

When is ACL reconstruction necessary?

ACL reconstruction is typically recommended:

• When the ACL is completely torn and causes significant knee instability.
• When the patient wishes to return to sports or high-impact activities that require knee stability.
• When other structures in the knee, such as the meniscus, are also injured.

A torn ACL typically occurs due to sudden twisting motions, changes in direction, or direct impact to the knee, commonly seen in sports like football, basketball, and skiing. Symptoms of an ACL tear include pain, a popping sensation at the time of injury, immediate swelling, knee instability (feeling like it gives out), and difficulty bearing weight or walking.

How is ACL reconstruction performed?

ACL reconstruction involves surgically replacing a torn ACL with a graft. The operation is performed under general anaesthesia, and the surgical site is sterilised.

During ACL reconstruction, small incisions are made around the knee to insert the arthroscope (a small camera) and specialised surgical instruments. The torn ACL is then removed, and a tendon graft is selected to replace it.

Tunnels are drilled into the femur (thigh bone) and tibia (shin bone) to anchor the new graft. The graft is threaded through these tunnels and fixed in place using screws, buttons, or other fixation devices. The graft is secured at both ends to ensure stability and proper tension.

Lastly, the incisions are closed with sutures or staples, and a sterile dressing is applied. Most patients go home the same day or after an overnight stay. Immediate care post-surgery involves managing pain with medication and ice packs. Crutches and knee brace are also typically used to protect the knee.

ACL reconstruction typically has a high success rate, allowing patients to return to their previous levels of activity and sports. The procedure typically lasts between 1 to 2 hours, depending on the complexity and type of graft used.

What type of grafts are used in ACL reconstruction?

There are three main types of grafts:

• Autografts: Tissues taken from the patient’s own body. Examples include the patellar tendon, the hamstring tendon, and the quadriceps tendon.
• Allografts: Tissues taken from a deceased donor. It removes the need for an additional surgical site.
• Synthetic grafts: Although less common, synthetic grafts are an option for patients who can’t use autografts or allografts. They are made from materials like carbon fibre or polyester.

Are there any risks or potential risks involved with ACL reconstruction?

Like any surgical procedure, ACL reconstruction carries risks and potential complications. Common risks include infections at the surgical site, blood clots like DVT (deep vein thrombosis) in the legs, knee stiffness, and graft failure or tear. It’s important for patients to be aware of these risks before undergoing surgery.

What is the typical recovery timeline after ACL reconstruction?

During the first month, physical therapy aims to restore range of motion and reduce swelling. Weight bearing is gradually increased as tolerated, and therapeutic exercises focus on gentle stretching and strengthening to promote healing and regain knee function.

After six months, patients typically begin to reintegrate into light activities such as jogging and agility exercises. Emphasis remains on strengthening key muscle groups including the quadriceps, hamstrings, and core muscles to enhance stability and support for the knee.

Full recovery from ACL reconstruction typically takes 6 to 12 months, with many patients able to resume their previous level of sports and activities around 9 to 12 months post-surgery, contingent upon their individual progress. During this phase, rehabilitation continues with a focus on maintaining strength and flexibility to prevent re-injury.

Long-term care involves regular follow-up appointments to monitor the knee's health and address any lingering concerns, ensuring optimal recovery and function over time.

To schedule an appointment with Mr Breck Lord, head on over to his Top Doctors profile today.