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When is ACL Surgery Necessary? Understanding When and Why You May Need It

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The anterior cruciate ligament (ACL) is a critical structure in the knee, providing stability and allowing us to perform everyday activities like walking, running, and jumping. When this ligament is torn—commonly during sports or physical activity—it can lead to instability and pain that often requires surgical intervention. But what exactly is ACL surgery, and why is it necessary? Let’s dive into the details.


What is ACL Surgery?

ACL surgery, or anterior cruciate ligament reconstruction, is a surgical procedure to substitute a torn ACL in the knee. Unlike some other injuries, a completely torn ACL does not heal on its own of if it does heal it is in a sub-optimal position, leading to instability. As a result, surgery is often needed to restore knee stability, particularly for active individuals or athletes.

During the procedure, the surgeon removes the remnants of the ACL and replaces it with a graft—a piece of tendon harvested from either your own body (autograft) or a donor (allograft). This graft replaces the torn ligament and allows the knee to be more stable.


Who Needs ACL Surgery?

While not every ACL tear requires surgery, it’s often recommended for individuals who:

  • Experience knee instability that interferes with daily activities.
  • Want to return to high-impact sports or physical activities, such as football, netball, tennis, or skiing.
  • Have additional injuries, such as meniscus tears or cartilage damage, that require repair.
  • Are younger and lead active lifestyles.

Conversely, older individuals or those with lower physical demands may opt for non-surgical treatments, including physical therapy and bracing.


How is ACL Surgery Performed?

The procedure is typically performed using arthroscopic surgery, a minimally invasive technique involving small incisions. Here’s an overview of what happens during ACL reconstruction:

  1. Preparation: The patient is placed under general anaesthesia, sometimes combined with regional anaesthesia for pain management.
  2. Graft Harvesting: If an autograft is used, the surgeon removes tissue from the patellar tendon, hamstring tendon, or quadriceps tendon.
  3. Torn ACL Removal: The damaged ACL is removed, and the knee is cleaned to prepare for graft placement.
  4. Graft Placement: Small tunnels are drilled in the thighbone (femur) and shinbone (tibia) to secure the graft in place using screws or other fixation devices.
  5. Closing: The incisions are closed, and the knee is bandaged. The entire procedure usually takes 1–2 hours.

Recovery After ACL Surgery

Recovery from ACL surgery is a structured process that requires patience and dedication. Look out for my next blog specifically on recovery times and what affects your healing. While the specifics vary, here’s a general timeline:

  • Weeks 1–6: Rest and controlled movement with the help of crutches and a knee brace. Physical therapy begins to restore mobility.
  • Months 2–6: Focus on strengthening the knee and regaining range of motion through therapy.
  • Months 6–12: Gradual return to sports or high-impact activities, depending on your progress and meeting specific strength benchmarks.

Full recovery can take 9-12 months, but it varies depending on the individual and adherence to rehabilitation.


Types of Grafts Used in ACL Surgery

One of the most common questions patients have is about the type of graft used in surgery. The two primary options are:

  • Autograft: Tissue taken from your own body. Common sources include the patellar tendon, hamstring tendon, or quadriceps tendon. Autografts are often preferred for younger, active individuals.
  • Allograft: Tissue taken from a donor. Allografts are less invasive but may have a slightly higher risk of graft failure in younger or highly active patients.

Your surgeon will recommend the best option based on your activity level, age, and personal preferences.


Benefits of ACL Surgery

ACL surgery offers numerous benefits, including:

  • Restored Stability: Prevents the knee from giving out during movement.
  • Improved Functionality: Allows you to return to daily activities and sports.
  • Reduced Risk of Further Damage: Prevents additional injuries to the knee, such as meniscus tears or early-onset arthritis.

Risks and Considerations

While ACL surgery has a high success rate (approximately 85–90%), there are risks to consider, such as:

  • Infection
  • Blood clots
  • Damage to blood vessels/nerves/structures in knee
  • Stiffness or loss of motion
  • Graft failure or re-tearing

Working closely with your surgeon and physical therapist can significantly reduce these risks.


Is ACL Surgery Right for You?

Deciding whether to undergo ACL surgery depends on your lifestyle, goals, and the severity of your injury. Surgery is often the best option for athletes and active individuals, while others may manage with physical therapy and bracing. Consulting with an experienced orthopedic surgeon will help you make the right decision.


Final Thoughts

ACL surgery is a transformative procedure that restores knee function and stability, allowing many patients to return to the activities they love. By understanding the process, risks, and recovery, you can approach the journey with confidence. If you’ve recently torn your ACL or are considering surgery, contact my office on 02074594482 or email admin@londonhipknee.co.uk and I will be happy to guide you through every step.

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