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ACL RECONSTRUCTION SURGERY
ACL RECONSTRUCTION
The anterior cruciate ligament (ACL) is an important ligament contributing to the stability of the knee. It is most useful for changing direction ‘pivoting’, particularly at higher speed. Some patients may rehabilitate successfully with physiotherapy alone, but some patients, particularly those who enjoy pivoting sports (eg. rugby, football, netball, surfing, tennis or skiing) may require ACL Reconstruction Surgery to get them back to their active lifestyle. Performed by our orthopaedic surgeons, this procedure involves removing and replacing the torn ligament with a band of tissue called a tendon.
BENEFITS
Recovery of mobility
Some patients with ACL rupture find that even normal walking can give them a sense of instability, particularly when changing direction. An improvement in patient mobility should occur a few days after surgery, with further improvement in the following weeks and months.
The ability to return to work, sporting activity, and lead a normal, active life.
If an ACL rupture is preventing you from performing your normal job, or from playing the sports you enjoy, you may require ACL reconstruction.
PROCESS
ANAESTHESIA
SURGERY
POST SURGERY
ANAESTHESIA
Both general and local anaesthesia techniques are usually performed on ACL reconstruction patients to achieve the best outcome. An anaesthetist will help to determine the best method for each patient but generally you will have a general anaesthetic during the procedure and a local anaesthetic block to reduce discomfort for when you wake up.
SURGERY
The first step of ACL surgery is to harvest a replacement tendon. The surgeon will extract this ‘tissue graft’ from an area of the patient’s leg – most commonly from the hamstring – or, in rarer cases, from a cadaver donor.
The surgeon will then remove the torn ACL using an arthroscopic ‘keyhole’ technique and replace it with the graft. Two drill holes are made in the femur and the tibia, through which the graft is pulled, and a surgical fastening device is used to fix the graft in place. The surgical wounds are then closed with sutures.
While the length of the surgery will depend on the extent of the patient’s damage and the type of graft being harvested, ACL reconstruction is an outpatient procedure, meaning that the patient can go home once they have recovered from anaesthesia on the same day or the day following.
POST SURGERY
Following surgery, the patient will be taught to walk with crutches and may be fitted with a knee brace or splint, particularly if a meniscal repair is required at the same time. The RICE first aid model – Rest, Ice, Compression, Elevation – can be used to minimise pain and swelling. The treating doctor will likely recommend the use of over-the-counter pain relief, or in some cases, stronger prescription medication. Physical therapy in the weeks following surgery will aid in the healing process and increase joint function and flexibility.
RECOVERY TIMELINE
Recovery time varies according to the individual, particularly if other surgical repairs are required at the same time as the ACL reconstruction such as meniscal repair or cartilage repair. Recovery is a gradual process with progressive escalation of activity level. Whilst patients are usually walking almost straight away, and able to return to desk-based work after approximately 2 weeks, the return to pivoting impact sports such as rugby can take 6-9 months.
Postoperative inflammation and pain is mild to moderate in the initial three weeks following surgery, and crutches should be used to aid mobility. In some cases range of motion and weightbearing will be greater restricted, for example due to repair of a meniscus or cartilage damage. The patient should slowly return to low-impact activities as their healing evolves, in consultation with your surgeon and physiotherapist.
WEEKS 1-2
The affected limb must be rested as much as possible. Crutches should be used for at least two weeks to aid walking. Gentle strength exercises will help the patient to regain control of the leg muscles and restore range of motion, particularly the ability to straighten (‘extend’) the knee. Patients can return to desk based work after approximately 2 weeks if their pain has adequately settled.
Nov 09, 2017WEEKS 3-6
Further improvement occurs in knee stability and muscle strength. Patients may be able to walk without an assistive device
Nov 09, 2017WEEKS 7-12
Muscles begin to recover their normal function and gait becomes more normalised. The knee is capable of bearing greater weight, and exercises will build muscle strength. Certain low impact, controlled sporting activity like stationary cycling can be commenced and heavy work resumed.
Nov 09, 2017MONTHS 3-6
Provided the patient has recovered adequately, he/she may be able to return to running, jumping, or impact activities. Exercises are targeted at protecting the replacement ACL from future injury.
Nov 09, 2017MONTHS 6-9
Preparation for your return to high speed ‘pivoting’ sports such as rugby, football, tennis, skiing and surfing is dependent on sports-specific exercises designed to prevent re-rupture
Nov 09, 2017MONTHS 9-12
return to competitive sport. This is variable and needs to be discussed in close consultation with your physiotherapist based on how you are progressing.
Nov 09, 2017SURGICAL RISKS
Like all surgical procedures, ACL reconstruction carries risks. However, it is considered a relatively safe procedure, with the most common risks being pain and bleeding at the surgical site. Rare complications include infection, graft rejection, knee stiffness and cyst formation around the graft site. Re-rupturing of the ACL graft can occur, which is why your rehabilitation protocol is important to follow with the guidance of your physiotherapist and surgeon.
RECOVERY AND EXERCISE
Physical therapy is an essential element of ACL reconstruction recovery. An individualised rehabilitation program will be developed for each patient’s unique needs. The initial focus will be on regaining full knee straightening (‘extension’) and improving flexion. You will then gradually increase the resistance involved with your exercises, beginning with heel slides, standing hamstring curls, and mini squats. Single leg standing can enhance balance and adjustment to joint positioning. Muscle strengthening and endurance exercises will progress to complement individual healing, and may include rotational tibial mobilisations, pool jogging, and lateral lunges in the later phases of physical therapy. The final stages will focus exercises specific to the sports you wish to return to.
FAQS
How long before I can drive after ACL Reconstruction?
You should drive when your brake response time (BRT) has returned to normal. This normally occurs from four to six weeks after right-sided ACL reconstruction and from two to three weeks after left-sided ACL reconstruction.
I have wound issues after my operation- what do I do?
A small amount of blood can appear under the dressing at the surgical site in the first few days following ACL reconstruction. However, if the ooze breaches the waterproof dressing or you have any wound ooze after the first few days, please call the Sunshine Coast Orthopaedic Group.
How far should you bend the knee after an ACL Reconstruction?
Restoring knee flexion after an ACL reconstruction is an important process that should be monitored closely by the treating surgeon depending on whether another structure has been repaired at the same time requiring protection. Most patients will be advised to perform stretching exercises regularly after an ACL reconstruction, and these exercises will increase the affected knee’s range of motion gradually. Full knee flexion is typically achieved four to six weeks postoperatively. You should follow your surgeon’s advice closely for best results.
Inside of the knee hurts after my ACL Reconstruction. What do I do?
A sensation of pain from inside the knee is common after ACL reconstruction. With adequate pain relief, patients usually tolerate this pain well. However, if you experience excessive pain or a sudden increase in pain, seek medical attention.
For more information on ACL surgery or to book an appointment, contact Sunshine Coast Orthopaedic Group.
MEET OUR ACL SURGEON
DR SHANE BLACKMORE
Orthopaedic Surgeon
Dr Shane Blackmore specialises in sports injuries, arthroscopic and reconstructive surgery of the knee. After completing subspecialty fellowship training in London and New York, he returned to Melbourne with world-class experience in the latest arthroscopic and minimally invasive surgical techniques.
He is one of only a few Australian trained surgeons to have his training accredited by both the Arthroscopic Association of North America (AANA) and American Orthopaedic Society for Sports Medicine (AOSSM).
Shane has subspecialty training focused on the latest arthroscopic techniques for knee ligament reconstruction (ACL tears), meniscal repair and transplant, cartilage restoration and joint preservation. Shane has a special interest in multi-ligament (complex) knee injuries and revision ligament reconstruction for failed ACL reconstructions.
Shane has published articles and book chapters, as well as technique videos on many aspects of knee surgery.
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Sunshine Coast University Private Hospital
Suite 12, 3 Doherty Street, Birtinya, QLD, 4575
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