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Considering ACL repair surgery?

The anterior cruciate ligament (ACL) is a strong band of tissue inside your knee joint. It's main role is to help control the stability of our knee and prevent unnecessary movement. Tearing this ligament can result in pain, swelling and difficulty in trusting the knee to help us walk and run.

Most injuries to the ACL occur as a result of a twisting injury when playing sports such as rugby, tennis, skiing, netball and football. Some people report feeling a popping sensation in their knee and are often unable to keep on playing. The knee becomes swollen and they are unable to hold much of their weight through it. 

To diagnose a ACL tear, you may be seen by a Physiotherapist or an Orthopedic doctor. They will talk to your about how the injury happened, give the knee a physical examination and you may be refereed for an MRI scan of the knee.  

If you have torn your ACL, the team at the hospital will discuss with you the options. The first option would be to try non-surgical rehabilitation. In some patients, this can work very well and although it can take time they can make a very good recovery. Find out more about this option below.

 

The second option would be to have the ACL surgically repaired. This is done via an arthroscopy (key hole surgery). You can find out more about this option below.  

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Do I need to have surgery?

The first thing to remember is that rehabilitation for a ACL tear takes time. For most patients, it can be 12 months before they feel fully happy with their knee. 

A surgeon will discuss with you the pros and cons of having your ACL surgically repaired. In most cases, surgery is performed when the patient needs or wants to get back to a high level of activity e.g a return to sport or a very manual occupation. Some of the common reasons for not having surgery might include:

  • Not needing to return to playing sport or manual work

  • Not being medically well enough to have surgery

  • It not being possible to repair the ACL due to its age or condition

  • Not getting any giving way of the knee

You do not need to rush into a decision to have surgery or not. Often a surgeon will encourage you to attend physiotherapy and start the rehabilitation process and give you time to think about it. It can be possible to not have surgery and return to everyday activity. 

You can check out the early stage rehabilitation exercise below.

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ACL Surgery

 

When you tear the ACL, you cannot just simply stitch back together. The surgeon will first remove the torn ligament and replace it with another strong piece of tissue. At Harrogate, the muscle at the back of your upper leg, known as the hamstring is often used to do this. This is known as a Hamstring Graft.

In most cases, ACL surgery aims to allow you to return to your previous level of activity. You can read more about the Risk Vs Benefits here.

Recovering from surgery usually takes around 6 months, but it could be up to 12 months before you're able to return to full training for your sport.

Surgery on your knee can only go ahead when you have been able to reduce the swelling of the knee and regain most of the movement. It is important that you start your early stage rehabilitation exercises as soon as you feel able. Speak to your Physiotherapist for more information.

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Risk vs Benefits

 
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Early Stage Rehabilitation

What are the risks?

  • Wound infection - rare and usually involves the skin. Occasionally a deep infection can occur, the risk is less than 1%.

  • Stiffness – knees can become stiff after knee surgery. This usually resolves with physiotherapy but a small number of patients may require further surgery to address this.

  • Nerve injury – there is a very small risk to nerves around the knee. The risk is less than 1%.

  • On-going pain – 5-20% of patients will have some on-going discomfort / pain after surgery.

  • Anesthetic - This is the medication used to put you to sleep for the operation. You should discuss this with the Doctor. It will be different for each patient.

  • Blood clot - Risk of blood clot in the leg (deep vein thrombosis or DVT) is rare following knee surgery. Prevention is by physical means of stockings and pumps in theatre and early mobilisation after surgery (walking). Keeping well hydrated after surgery is also advised (drinking water).

  • Re-rupture - Rare and usually happens when rehabilitation has not been followed correctly. Re-rupture would need further surgery to fix.

The main benefit for surgery is that patients can expect to return to their previous sport or activity. This can take 12 months of intensive physiotherapy & rehabilitation. Some patients unfortunately do not manage to return to play. This is often due to a lack of confidence or trust that their knee will perform the same way it used too.

 
ACL Rehabilitation
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What can I expect?

 

So when can I start...

Leaving Hospital
Most patients leave hospital the same day. Some patients may need to stay overnight.

Driving

Normally 2 weeks.

The law states that the patient should be in complete control of the car, it is their responsibility to ensure this and to inform their insurance company about their surgery.

Crutches
Usually 2 weeks.

Most people will need to use crutches for 2 weeks after their operation

Medication
The hospital will ensure you have the correct medication & pain relief when you go home. This can be different for each patient

Manual job
Up to 6-8 weeks; may need to modify activities for 2-3 months

Sedentary job
2-3 weeks as tolerated

Running
Usually 6 weeks.

You should not run until you have been given the clear by your Physiotherapist

Swimming
Usually 4-8 weeks.

This depends on the intensity and choice of stroke. Discuss this with your physiotherapist

High Impact Sport
Usually 12-18 months.

It takes time for the graft and your knee to become strong enough to deal with the high impact stresses of competitive sport 

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This is only a guide. It may be different for each patient. Speak to your healthcare team if you have any questions.

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