Anterior Cruciate Ligament (ACL) Reconstruction

Anterior Cruciate Ligament (ACL) Reconstruction is performed when the knee is persistently unstable. It is one of the most common knee operations performed and has excellent success rates with return to competitive sports within 1 year.

The procedure is performed as a day case (sometimes patients are kept in overnight) and is done via keyhole (arthroscopic) surgery with a small incision made to obtain the graft (usually your own hamstring tendons).

MRI showing normal ACL

You will have had a MRI to confirm the diagnosis and this will show any other abnormality too (meniscal, cartilage or other ligament injury)

MRI showing torn ACL

What does surgery involve?

The surgery is performed as a day case under general anaesthetic. Via key-hole surgery, tunnels are drilled in the femur and tibia and the graft is secured at both ends.

The graft is fixed in the femur with an endobutton, and in the tibia with a screw.

Which graft is best ?

There are a few different choices for ‘making’ the new ligament. These include using your own patellar tendon, your own hamstring tendon (the two commonest grafts used), or a donor graft from a cadaver (treated to reduce infection and immune response).

Image showing the different types of graft used.

My own preference is to use your own hamstring tendons as this is mechanically the strongest graft. On occasion, I do also use allograft. I will usually have a detailed discussion with each patient on the pros and cons of each type of graft prior to surgery.

One important point is that studies have shown no real difference in outcomes where either a patellar tendon or hamstring tendon has been used. There is a higher incidence of anterior knee pain and development of patello-femoral arthritis in patients who have had a patellar tendon ACL reconstruction.

What is the recovery ?

You will be mobile immediately after surgery and able to put all your weight on the leg. Crutches are used for 4-6 weeks and physiotherapy starts at 2 weeks (although you will be given exercises to perform straight away).

There are various milestones to achieve in your rehabilitation (e.g. running at 3 months, pivoting at 5 months) and your recovery depends on when you reach these milestones – not everyone is the same. Full competitive sport resumes at 9-12 months.

What are the outcomes ?

Complications include infection, clots and stiffness. All are very rare. The major complication following an ACL reconstruction is graft failure and the overall risk is 8-10%. Factors which contribute to graft failure are as follows:

  • Poor surgical tunnel placement
  • Failure to recognise an associated ligament injury (commonly the postero-lateral corner)
  • Graft fixation failure
  • Impingement
  • Trauma leading to the graft being stretched at a vulnerable stage (1st 6weeks)

I want to thank Mr. Datta for taking such good care of me during both hip replacement procedures. It was my first major surgery and he helped calm my nerves. Both surgeries were successful and the after care was excellent. I am now completely pain free and able to do things I was not able to do for a number of years.

S Kirby

I must say my overall experience at Spire under Mr Datta was first class and I am very grateful to all involved

Peter L

My care and treatment has been excellent. From my first consultation through to my surgery, I have been kept well informed and have had all the information I’ve needed to ensure the surgery went well and that I make a speedy recovery. I would highly recommend Mr Datta.

Mr King

I had a total knee replacement done and had the best care. Yes did experience a long wait to go to surgery but that's expected in most hospitals. Was in for 3 days and couldn't fault the care, nurses and cleanliness of the hospital. Lovely food. One nurse in particular always managed to make me smile

P Elliott

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