Knee ACL reconstruction surgery
ACL Reconstruction: Overview
The reconstruction of your anterior cruciate ligament (ACL) is commonly referred to as a “knee reconstruction”. The ligament, which is located in the middle of the knee, controls the movement of the two main knee bones, the tibia and the femur. This ligament is particularly important for twisting and turning movements such as those that are required in football, netball and other sports where pivotal movement is required.
ACL injuries are often traumatic events and a ‘popping’ sound may be heard followed by swelling and pain. The ACL doesn’t have a great ability to heal after injury, so patients who have torn this ligament are often considered for reconstruction. Tearing of the ACL can cause instability, especially for those who continue activities that require a sudden change in direction. There is also a risk of damage to the cartilage, meniscus or ligaments which in turn puts the knee at risk of developing premature osteoarthritis (although surgery may not stop osteoarthritis developing later in life).
There is the option to choose rehabilitation over surgery with the aid of a knee brace and physiotherapy however the success of this depends on the amount of damage to the ACL, your lifestyle and your ability to modify activities during the healing process. Consideration for surgery also depends on the level of athletic activity you wish to pursue.
Knee reconstruction is usually an elective procedure therefore from a medical point of view, it is important to discuss all options with Dr Rodda prior to making a decision.
Process of ACL reconstruction surgery
The knee must be prepared prior to surgery by reducing swelling through regular icing and wearing a compression bandage or sleeve. Having the heel supported on a rolled towel and using the quadriceps at the front of the thigh to lock the knee straight out (one of the key aims in surgery is to restore full extension of the knee) is an important and vital exercise. Bending of the knee is also important which may be helped by riding a bicycle.
ACL reconstruction is performed arthroscopically (keyhole surgery) under general anaesthetic, either using the patient’s own tendon tissue (an autograft, usually of the patella, quadriceps or hamstring tendon) or donated tendon tissue (an allograft). A tunnel is created in the femur (or thigh bone) and tibia (shin bone) from inside the knee, into which the new tendon is passed and fixed.
On completion of the operation, the surgical location is treated with local anaesthetic. This gradually wears off over the next eight hours and pain control from then on is usually via pain-relief tablets. Your stitches are dissolvable so don’t require further attention and any required dressings are waterproof.
Most patients go home the morning after surgery, although it can also be performed as a day procedure depending on the level of your injury. Prior to your discharge, physiotherapist will instruct you on how to conduct post-operative exercises and how to use your crutches which you will need for 2-4 weeks. Bruising and swelling are common, but to be expected after this kind of surgery and are helped by correctly following your instructions for recovery.
It is important that you rest during the first week after surgery. You should spend most of your time on a bed or couch with your leg elevated and continue with regular icing.
Dr Rodda will check your wound after a few weeks to ensure that it is healing as expected. He will also recommend exercises to encourage the knee to extend out straight and a physiotherapy program to restore function of the quadriceps muscle at the front of the thigh.
Visually there is a vertical or oblique scar on the front of the knee along with two small scars either side from the incisions that allow the arthroscope and surgical instruments to do their job. A further incision may be made towards the back of the knee if repair to the cartilage is required.
Depending on the type of work you do (a desk job or heavy manual labour) it can vary between 2 weeks to 3 months before you can consider a return to work. Most patients are able to recommence sporting activities after 4-6 months however it usually takes around 12 months to return to full functionality.
Benefits of ACL reconstruction surgery
The goal of ACL surgery is:
- The reduction of pain and inflammation associated with injury to the knee
- The restoration of normal joint anatomy, static and dynamic stability and prevention of damage to other structures within the knee
- The ability to return to work, sporting activity and lead a normal active life.
Risks of ACL reconstruction surgery
- Antibiotics are given at the time of surgery to reduce infection however infection of the wound can still occur and sometimes it can get into the joint. This is a serious complication and requires admission to hospital, additional surgery and intravenous antibiotics.
- A blood clot can form in the veins in the legs. This can cause swelling of the foot and ankle. The clot can also be dislodged and carried to the lungs causing a pulmonary embolus with chest pain and breathing difficulties. This is a serious condition however the risk is statistically very low. Please advise Dr Rodda before your surgery if you think you are at high risk.
- A small area of skin on the outside of the knee is usually numb after surgery and your shin can also sometimes feel numb. This numbness can sometimes be permanent although the area covered usually gets smaller with time.
- If you require a donor graft it is very common to feel the sensation of something tearing at the back of the knee after between 3-8 weeks of surgery. This is simply stretching of the scar tissue and usually settles after a few days. Sometimes a patella graft can cause pain at the lower end of the patella, even as late as 9-10 months after surgery, but this also usually settles with time.
- Occasionally a device used to hold the graft in place begins to show a few months after surgery. If this is a problem, it can be removed without risk to the graft.
Why should I consider Knee Arthroscopy?
If you have suffered an injury to your ACL as a result of an accident or sporting incident, you may be considered for surgery if rehabilitation is not sufficient to restore you to full mobility.
Who is suitable for surgery?
Most patients who have suffered a torn ACL are suitable for surgery however those at risk of a blood clot or with a history of other medical problems should discuss it with Dr Rodda before proceeding.
Will I have much pain?
All surgical procedures involve a certain amount of discomfort however the use of local anaesthetic and iced water after surgery, along with recommended recovery programs and physiotherapy reduce any pain and discomfort relatively quickly.
What happens after surgery?
After the initial recovery period where you are monitored in hospital, most patients go home the same day or morning after surgery. Prior to your discharge, Dr Rodda will instruct you on how to conduct post-operative exercises and how to use your crutches which you will need for 2-4 weeks. You may experience some bruising and swelling which is helped by correctly following your instructions for recovery.
What happens once I’m home?
It is important that you rest during the first week after surgery. You should spend most of your time resting with your leg elevated and continue with regular icing. Dr Rodda will check your wound after a few weeks to ensure that it is healing as expected. He will also recommend exercises which encourage the knee to extend out straight and a physiotherapy program to restore function of the quadriceps muscle at the front of the thigh.
Depending on the type of work you do it can vary between 2 weeks to 3 months before you can consider a return to work. Most patients are able to recommence sporting activities after 4-6 months however it usually takes around 12 months to return to full functionality.