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What is ACL reconstruction?
ACL reconstruction is a procedure where a torn anterior cruciate ligament (ACL) is repaired.
The ACL is a tough band of tissue that connects your thighbone to the shin bone within the knee. The ACL runs diagonally inside the knee and helps it stable. It also helps to control the backwards/forwards movement in your lower leg.
ACL injuries are one of the most common knee injuries and frequently occur in sports such as football, rugby, skiing, tennis and squash.
Common causes of an ACL injury include:
- Sudden twisting movements (frequently occur when ski bindings do not release during a fall)
- Pivoting with your foot firmly planted
- Collisions (such as in a football tackle)
- Stopping or changing direction suddenly
- Landing incorrectly after a jump
If you injure your ACL, you may hear a popping sound and will notice pain. Your knee will swell within an hour or two of the injury and it could also feel unstable. You may also notice your knee’s range of motion is reduced and certain movements, like turning on the spot, become very difficult.
ACL reconstruction is generally recommended if:
- You’re an athlete and want to continue in your sport, especially if it involves jumping or pivoting
- More than one ligament is injured
- You have a torn meniscus (shock absorbing cartilage) that also requires repair
- Your knee keeps giving way or feels like it’s going to
- You’re young (though other factors, such as activity level and knee instability, are more important than age)
How to pay for your treatment
If you’re… paying for yourself
Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.
For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.
If you’re… insured
St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.
Appointment
You will have an initial consultation with a specialist knee surgeon.
Treatment plan
During this appointment, you will go through your medical history, have a knee exam and if needed, be referred for an up-to-date scan (such as MRI) of your knee. If surgery is recommended, your doctor will explain the risk and benefits of surgery and what to expect from recovery. Together, you will decide whether an ACL reconstruction is the best option for you.
Prehab
Your knee needs to be in the best condition possible before surgery, as this will lead to better outcomes. Once your swelling has gone down, you should follow your physiotherapist’s exercise programme. This will aim to increase your knee’s range of motions, reduce stiffness, and strengthen the muscles near the knee.
Pre-op assessment
If you decide to go ahead with surgery, you will need to come in for a pre-assessment, which is a standard ‘fitness for surgery’ check.
Surgery
The surgery will take 1 – 3 hours. You will be able to walk the same day with the help of a knee brace or crutches. You can go home the same day.
Aftercare
You will need to keep your wound clean and dry, take pain relief and have physiotherapy consistently. You will not be able to fly short-haul for six weeks or long-haul for 12 weeks. We have an excellent therapies team at our hospital that can support you throughout your recovery.
Follow-Up
You will have a follow-up appointment with your doctor at two weeks, where any stitches will be removed. If needed, you may have further check-ups at 6 weeks, 12 weeks and 6 months.
Frequently asked questions about ACL surgery
Your specialist will assess the extent of your ACL damage, any other knee injuries, and how these impact your daily life. If your knee is stable, non-surgical options like pain relief and physiotherapy may be recommended. However, if you experience instability or difficulty with activities, ACL surgery could be beneficial.
Preparation includes ‘prehab’ to increase your knee’s range of motion and strengthen muscles for better post-surgery outcomes. You’ll also need a pre-assessment for fitness checks and antibacterial wash to reduce infection risk. Our therapies team can support you with prehab exercises in the run-up to surgery if needed.
If you’re taking blood thinners (e.g., warfarin or aspirin) or NSAIDs (e.g., ibuprofen), inform your doctor as you may need to stop these a week prior. Your doctor will provide specific instructions based on your medication.
ACL reconstruction is a day procedure, so you’ll usually go home the same day. Stop eating six hours and drinking two hours before surgery. Arrive in loose, comfortable clothing with essentials such as a toothbrush, charger, and any prescription medications. A nurse will check your vitals, and your doctor will review the procedure and have you sign a consent form.
You’ll be given anaesthesia, either general or spinal with sedation. The surgeon will use an arthroscope to remove the damaged ligament and replace it with tissue from another source. Post-surgery, you’ll be monitored before discharge. Have someone ready to collect you, as anaesthesia effects can last 24 hours. For the first two weeks, keep your leg elevated, take prescribed painkillers, and use crutches or a knee brace as needed.
Initial recovery involves rest, followed by regular physiotherapy from week two to help with balance, strength, and knee flexibility. Most can resume office work within 2-3 weeks and driving within 3-4 weeks. Avoid flying for at least six weeks (short-haul) and 12 weeks (long-haul). While ACL recovery takes up to six months for full function, our physiotherapy team is available to support your progress throughout.
ACL reconstructions are common procedures. However, all surgeries carry risks, such as infection, developing a blood clot or having an unexpected reaction to the anaesthetic.
An ACL reconstruction could also result in complications such as:
- Continued instability. This could happen if there’s a problem with the placement of your graft.
- A tear in the new ligament that needs to be repaired with further surgery.
As such, make sure you follow your doctor’s advice, take good care of your wounds and don’t rush your recovery.
Medically reviewed by Mr Sujith Konan - MBBS MD(res) MRCS FRCS(Tr&Orth), Honorary Associate Professor (UCLH)