Orthopaedic Expert Care You Can Trust
Anterior Cruciate Ligament (ACL) Reconstruction
Expert Orthopaedic Care for ACL Injuries
Welcome to London Hip and Knee Clinic, where we specialise in advanced orthopaedic treatments, including Anterior Cruciate Ligament (ACL) reconstruction. Whether you’re an athlete striving to get back on the field or an individual aiming to restore stability and mobility, we are here to guide you through your journey to recovery.What is the ACL?
The anterior cruciate ligament (ACL) is one of the key ligaments in the knee joint, connecting the femur (thighbone) to the tibia (shinbone). It plays a crucial role in stabilising the knee, particularly during activities that involve pivoting, sudden stops, or changes in direction.
Common causes of ACL injuries:
- Sports-related activities like football, basketball, netball, tennis, badminton, or skiing.
- Direct impact to the knee during accidents.
- Non-contact mechanisms such as sudden pivoting or awkward landings.
When is ACL Reconstruction Necessary?
While some minor ACL injuries can heal with physical therapy and bracing, complete tears often require surgical reconstruction (especially in individuals participating in pivoting sports). Reconstruction is recommended if:
- You experience persistent knee instability (you lack full confidence in your knee, and it can unpredictably buckle under pressure)
- You wish to return to high-demand sports or activities.
- Non-surgical treatments has not restored full stability or has not allowed you to return to activities you enjoy
There is associated damage to other knee structures, such as the meniscus or other ligaments in the knee.
The ACL Reconstruction Procedure
1. Pre-Surgical Evaluation
Prior to surgery, during our initial consultation, I will perform a comprehensive evaluation (this includes history, examination and imaging studies like MRI and X-rays). In our follow-up consultation we will review the imaging together and decide a tailor-made management plan.
I always recommend physiotherapy to strengthen the surrounding muscles and reduce swelling (regardless of whether we decide to proceed with surgery or not). I work with lots of excellent physiotherapists throughout London and Essex and I will guide you to one that is convenient for you. It is important that you regain full movement (i.e. you can fully straighten and bend you knee) prior to surgery.
2. Preparation for ACL reconstruction
Proper preparation is essential for a smooth ACL reconstruction surgery and successful recovery. Here’s what you can do to get ready:
• It is very important to engage with pre-surgery physical therapy (prehabilitation) to reduce swelling, improve knee range of motion, and strengthen surrounding muscles.
• Lifestyle Adjustments
a. Stop smoking, as it can hinder healing.
b. Maintain a balanced diet to support your body’s recovery.
c. Arrange for help at home, as you may need assistance with daily tasks during the initial recovery period.
• Prepare Your Home
a. Create a recovery-friendly space with easy access to essentials like crutches, ice packs, and medications.
b. Remove tripping hazards like rugs or clutter to avoid falls.
• Surgery Day Preparation
a. Follow my instructions about fasting before the procedure (usually no eating 6 hours before admission time and no water up until 2 hours before)
b. Wear loose, comfortable clothing, and arrange for someone to drive you home after surgery. As the procedure is done under a general anaesthetic, an adult will need to stay with you for 24 hours.
By taking these steps, you’ll be well-prepared for surgery and on your way to a successful recovery. If you have any questions about preparing for ACL reconstruction, feel free to contact our office for guidance
3. Surgical Technique
I perform ACL reconstruction using minimally invasive arthroscopy (key-hole surgery). The damaged or missing ACL has to be replaced by a new ligament. This is called a graft. Grafts can be taken and used from your own body (autograft) or from a donor body (allograft) There are several graft options:
• Hamstring tendon from your own knee/thigh
• Bone-patellar tendon-bone composite graft from the front of own knee
• Donor tendon graft (allograft)
• Synthetic (artificial) graft
During the procedure:
• Small incisions are made to insert a camera (arthroscope) and surgical instruments.
• A slightly bigger incision is made to harvest your hamstring tendons which I use to replace your torn ACL.
• Once torn ACL is removed, bone tunnels are drilled in the femur and tibia to anchor the graft, mimicking the natural ACL
• The graft is positioned and secured using a small but very strong metallic pin on your femur and a biocomposite screw in your tibia (this gets absorbed into your bone).
The procedure usually takes about an hour (or longer if other things in the knee need to be sorted out at the same time, like a meniscal tear). It is done on an outpatient basis, so you usually go home the same day.
Recovery and Rehabilitation
Post-Surgery Expectations
• Immediate Care: Pain management, icing, and elevation to reduce swelling.
• Swelling: This is inevitable immediately after surgery. As well as simple icing, other devices such as Cryocuff and Game Ready really accelerate in getting the swelling down speed up recovery.
• Brace and Crutches: Crutches will be used to protect the knee and aid mobility. A brace is used when other surgery is performed in the knee as well as the ACL reconstruction (e.g. meniscal repair other ligament repairs)
Rehabilitation Timeline
1. Weeks 1-6: Focus on regaining range of motion, reducing swelling, and light strengthening exercises.
2. Weeks 6-12: Progressive strengthening of the quadriceps, hamstrings, and core muscles.
3. Months 3-6: Advanced strength training, balance exercises, and low-impact activities.
4. Months 6-12: Return to sports-specific training and gradual resumption of full activities.
Recovery time varies, but most patients achieve full functionality within 9-12 months. To gain a deeper understanding , please click on the link below to download our comprehensive rehabilitation guide.
https://londonhipknee.co.uk/wp-content/uploads/2024/02/Melbourne-protocol-ACL-Rehab.pdf
Risks and Complications
As with any surgical procedure, ACL reconstruction carries some risks, including:
• Infection
• Blood clots
• Damage to blood vessels, nerves and structure inside the knee
• Graft failure
• Pain
• Swelling
• Stiffness or reduced range of motion
Our team employs the latest techniques and follows strict protocols to minimize these risks and ensure the best outcomes.
Frequently Asked Questions About ACL Reconstruction
- What are the signs that I need ACL reconstruction?
If you experience persistent knee instability, difficulty with pivoting or turning, frequent giving way of the knee, or if you want to return to high-demand sports, ACL reconstruction may be necessary. A thorough evaluation by your orthopaedic surgeon will confirm the need for surgery.
- How long does ACL reconstruction surgery take?
The procedure typically takes 1 to 2 hours (depending on whether extra surgery is needed on other structures in the knee) and is performed on an outpatient basis, meaning you can usually go home the same day.
- Is ACL reconstruction painful?
You may experience some discomfort after surgery, which is managed with medications, icing, and elevation. Advances in anesthesia and post-operative care have made the procedure much more comfortable for patients.
- What types of grafts are used, and how are they different?
- Autograft (your own tissue): Preferred for younger, active patients. These heal faster but may cause soreness at the donor site.
- Allograft (donor tissue): Often used for older or less active individuals. It eliminates donor site pain but may take slightly longer to heal and can be associated with higher re-rupture rates
Your surgeon will recommend the most suitable graft based on your needs.
- How soon can I return to sports after ACL reconstruction?
Return to sports typically occurs 6-12 months after surgery, depending on the type of sport and your adherence to rehabilitation. High-impact sports like soccer or basketball may require closer to 9-12 months.
- What is the success rate of ACL reconstruction?
The success rate is over 90%, with most patients regaining stability and returning to their desired activities. Factors like rehabilitation commitment and lifestyle choices influence outcomes.
- Will I need physical therapy after surgery?
Yes, physical therapy is critical for a successful recovery. Therapy focuses on restoring strength, flexibility, and stability in a progressive manner tailored to your condition.
- Can an ACL tear heal without surgery?
Partial tears may heal with physical therapy and bracing, but complete tears usually require surgical reconstruction for individuals who want to maintain an active lifestyle or experience ongoing knee instability.
- Are there any risks associated with ACL reconstruction?
As with any surgery, there are risks, including infection, stiffness, blood clots, or graft failure. However, these risks are rare, and modern surgical techniques minimize complications.
- Will I develop arthritis after an ACL tear or reconstruction?
An untreated ACL tear can increase the risk of arthritis due to instability and wear on the cartilage. ACL reconstruction can reduce this risk but does not eliminate it completely.
- How much does ACL reconstruction cost?
The cost can vary depending on factors like insurance coverage, the surgical facility, and the type of graft used. In my practice, utilising hamstring tendon autograft, the self paying all-inclusive cost to you is around £8200 to £8990 (hospital fees, surgeon and anaesthetic fees, and rehabilitation costs).
- Can I drive after ACL surgery?
You can usually drive within 2-6 weeks after surgery, depending on which leg was operated on and your ability to control the vehicle safely.
Why Choose Mr Parag K Jaiswal?
• Expertise: I have extensive training in hip and knee surgery and consequently am highly skilled in this area. I use advanced surgical techniques and personalised treatment plans to achieve the best possible outcome for my patients. As sportsman myself, I completely understand how important its to return to your active lifestyles as quickly and safely as possible.
• State-of-the-Art Facilities: Advanced imaging and surgical technology for precision care.
• Personalised Care: Tailored treatment plans to meet your unique goals and lifestyle needs. Excellence whilst delivering compassionate care is something I strive for when treating each of my patients. Please see the review below as a typical example.
• Comprehensive Rehabilitation: Close collaboration with physical therapists to optimize recovery.
Contact Us
Ready to reclaim your mobility and confidence? Schedule a consultation today by calling us at 02074594482 or emailing admin@londonhipknee.co.uk
Let me help you get back to doing what you love.
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Disclaimer: This information is for educational purposes and does not replace professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment recommendation
