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ACL Tear and Reconstruction

Treatment & Diagnosis of Anterior Cruciate Ligament Tear In Singapore

Are you suspect that you might have a torn and ruptured ACL? Please learn more about the symptoms and get immediate treatment because a torn ACL can't heal independently. Discover our advanced surgical solutions to regain strength and confidently return to your active lifestyle.

What is ACL Reconstruction?
ACL

Due to its limited capacity for self-repair, surgical intervention is often necessary to restore ACL integrity. Surgical procedures commonly involve grafting tissue from the patient’s body or a donor source to reconstruct the torn ligament, aiming to reinstate knee stability and function.

This revised version maintains a formal tone and introduces medical terminology relevant to ACL function and injury while avoiding overly ornate or artistic language. If further adjustments are needed, please let me know.

The Anterior Cruciate Ligament (ACL) And Its Role In Knee Stability

The ACL is a cruciate ligament in the knee that runs diagonally through the centre. It plays a vital role in stabilising the knee by connecting the femur and tibia to regulate movement and alignment at its core.

Essential Functions of the ACL:

  • Stability Assurance: The ACL assumes a crucial role in preserving knee stability, particularly during dynamic activities such as running and abrupt changes in direction. Limiting excessive forward movement of the tibia relative to the femur safeguards against potential injury stemming from destabilising forces.
  • Protection Against Hyperextension: One of its primary functions is to prevent the knee from extending beyond its physiological range, thus shielding against hyperextension injuries that may compromise joint integrity.
  • Sensory Input: Equipped with sensory receptors, the ACL provides essential feedback regarding knee position and movement, facilitating proprioception and aiding muscle coordination during various physical manoeuvres.

The Impact of an ACL Tear:

An ACL tear can significantly impair knee function, leading to instability and increased vulnerability to further damage. Symptoms typically include pain, swelling, instability, and occasionally a noticeable popping sensation upon injury.

Common Causes of ACL Injuries

ACL injuries represent a prevalent concern among athletes and individuals leading active lives, ranging from athletic pursuits to mundane occurrences.

Sports-Related Incidents:

  • Abrupt Changes in Direction: Swift directional shifts during athletic engagements can predispose individuals to ACL injury risks.
  • Jumping and Landing Actions: Activities involving elevation and subsequent impact upon landing can strain the ACL, increasing vulnerability to injury.
  • Sudden Stops: Abrupt halts in motion, characteristic of many sports manoeuvres, may subject the ACL to undue stress, precipitating injury.

Everyday Mishaps and Other Triggers:

  • Slips and Falls: Routine slips or falls, whether on uneven surfaces or due to environmental factors, can lead to ACL trauma.
  • Blunt Force Trauma: Direct impact or collision with objects or surfaces can impart significant force on the knee joint, potentially resulting in ACL injury.
  • Incorrect Exercise Techniques: Improper form or technique during exercise regimens can impose undue strain on the ACL, heightening the risk of injury.

Non-Contact Incidents:

Acknowledging that a substantial portion of ACL injuries occurs without direct contact, often during movements such as sharp pivots or awkward landings, is imperative. This underscores the importance of mastering proper biomechanics and maintaining optimal physical conditioning.

Common Causes of ACL Injuries

Gender-Specific Risks

Research suggests that female athletes exhibit a heightened susceptibility to ACL injuries compared to their male counterparts. Contributing factors may include disparities in muscle strength, hormonal influences, and anatomical nuances such as wider hips and altering stress distributions across the knees.

Symptoms of ACL Injuries

Decreased Activity Level:

  • Inability to sustain physical activity or sports participation post-injury.

Contact us promptly if you experience any of these symptoms following a knee injury.

Symptoms of ACL Injuries

Early recognition of ACL injury symptoms is paramount for timely intervention and effective management. Key indicators include:

Swelling:

  • Rapid onset, typically within 24 hours post-injury.
  • Observable swelling around the knee joint.

Pain:

  • Acute pain at the moment of injury.
  • Exacerbation of pain with weight-bearing activities.
  • Deep-seated or anterior knee pain.

Instability:

  • Sensation of knee instability or giving way.
  • Lack of confidence in weight-bearing activities.

Limited Mobility:

  • Difficulty in fully extending or flexing the knee.
  • Impaired movement due to pain or swelling.

Popping Sensation:

  • Perception of a distinct “pop” at the time of injury, although not universally experienced.

Joint Line Sensitivity:

  • Tenderness along the sides of the knee joint upon palpation.

When do I need an ACL Repair?

ACL tears typically do not mend on their own, due to their position within the knee and the interference of synovial fluid, which fills the knee joint. This fluid hampers the natural healing process of the ligament.

Therefore, for individuals with a complete ACL tear, especially those engaged in sports, surgery is often the recommended path. We specialise in both the surgical treatment and rehabilitation necessary to expedite your return to an active lifestyle. It is crucial not to make such decisions in isolation but to consult with a specialist for individualised advice. A deep understanding of the ACL’s anatomy is essential for effective reconstruction.

Our team frequently performs ACL reconstruction surgeries, offering guidance throughout your recovery journey.

Diagnosing and treating a torn ACL

How Do We Diagnose ACL Tears?

The diagnostic journey for ACL tears involves a multifaceted approach, encompassing clinical scrutiny and advanced imaging modalities. Below delineates our standard procedure for discerning ACL tears:

Clinical Evaluation

  1. Patient History Compilation:
    1. Gathering detailed information regarding the injury’s circumstances and immediate symptoms.
  2. Physical Examination:
    1. Thorough evaluation of the knee for indications of swelling, tenderness, and stability.
    2. Implementation of specific tests like the Lachman test and anterior drawer test to assess ACL integrity.

Imaging Tests

  1. X-rays:
    1. While not directly visualising soft tissues like the ACL, X-rays rule out bone fractures and assess overall knee alignment.
  2. Magnetic Resonance Imaging (MRI):
    1. Acknowledged as the gold standard for ACL injury diagnosis, MRI furnishes high-resolution images of soft tissues, affording a comprehensive depiction of the ACL and potential concomitant injuries to ligaments, menisci, or cartilage.

Arthroscopy

In scenarios where diagnostic clarity remains elusive or for a nuanced evaluation of injury severity, arthroscopic intervention may be warranted. This minimally invasive procedure entails the insertion of a miniature camera into the knee joint, facilitating direct visualisation of the ACL and internal constituents for precise assessment.

How Is ACL Surgery Performed?

During the procedure of an anterior cruciate ligament reconstruction, the patient is usually given general anaesthesia. Following the administration of anaesthesia, the knee is cleaned with antiseptic and draped. 

The surgery begins with an arthroscope placed into the knee joint using a small incision on the outer side. Another portal is made on the medial side. The knee is then examined using the arthroscope, and the integrity of the 3 compartments of the knee confirmed. The ACL tear is also confirmed.

Following the confirmation of the ACL tear, an  autograft is harvested from one of 3 common areas, the hamstrings, or the quadriceps, or bone patella bone graft from the patella tendon. An incision is placed and the autograft taken.  An allograft can also be used.  After graft harvesting, the graft is prepared on the back table to form a graft of sufficient thickness and strength. 

The surgeon takes down the old anterior cruciate ligament which has been detached, and it is removed. New femur and tibia tunnels are drilled and the graft pulled through. The graft is then pulled to tension and fixed to either metal buttons on the femur/tibia side, or screws. The knee is given a wash, and incisions closed. The patient is usually given a knee brace, and he starts walking on the same day or the next day.

Will I be able to achieve a full recovery?

In most cases, ACL surgery patients can anticipate a complete recovery and restoration of full knee function. The central variability lies in the pace of recovery:

Screening for New Patients

We have assembled some packages to help our new patients.

Single Knee

$235

Evaluation of Knee Pain with X-ray

Includes the following done on the same day:
Consultation
X-ray single knee – weightbearing AP, lateral, skyline view; and
Review in clinic after X-ray
(Exclusive of GST)

Immediately Post-Surgery:

  • Patients typically require crutches for support when walking immediately after the surgery.

1-2 Weeks Post-Surgery:

  • Many patients find that they can walk independently without crutches within the first to second week after the procedure.

4-6 Months Post-Surgery:

  • Patients often begin light jogging around 4 to 6 months following surgery.

Return to High-Impact Sports:

  • For those aiming to resume high-impact sports, it’s advisable to wait nine months to a year post-surgery to ensure adequate healing and minimise re-injury risk.

Overall, individuals who undergo ACL reconstruction surgery generally report improved strength and stability in their knee compared to their pre-surgery condition.

Prevention and Early Detection

Try to incorporate these practices to prevent injuries:

  • Strength Training: Concentrate on building the strength of the muscles surrounding the knee, like the quadriceps and hamstrings. This will offer enhanced support for the joint.
  • Proper Technique: Ensuring the correct execution of movements in sports and physical exercises can decrease the likelihood of an ACL injury.
  • Protective Equipment: For some sports activities, employing knee braces can provide extra stability and guard against movements that might cause injury.

Frequently Asked Question

Have questions? Our ACL specialists are here to answer them, providing you with the knowledge and confidence to make informed decisions about your health.

Following your surgeon's instructions regarding weight-bearing restrictions and your rehabilitation period lifestyle is important. Otherwise, the following complications can arise:

  • Restrictions in activity levels
  • Occurrences of bleeding
  • Experiencing mild discomfort in the knee
  • Risk of infection
  • Development of knee stiffness or weakness
  • Reduced flexibility or range of motion in the knee
  • Intermittent soreness within the knee area

The RICE method is often the first line of recommendation for managing a partially torn ACL. RICE encapsulates:

  • Rest: Allow the affected knee ample recovery time and avoid any activities that put weight on it or could strain it further.
  • Ice: The use of ice packs on the injured area to narrow blood vessels, which helps reduce blood flow and swelling.
  • Compression: Employing a bandage or similar compression tool to support thbeste injured knee, aiding in swelling reduction.
  • Elevation: Keeping the injured knee raised above the level of the heart, aiding in decreasing swelling by promoting fluid flow away from the injury site.

The cost of this surgery typically ranges from a few thousand to over $21,000. Varying with the surgical approach and additional services included.

Yes, ACL reconstruction is considered major surgery due to the complexity of the procedure and the importance of the ACL in knee stability and function.

The best ACL surgery depends on the patient's specific situation, with autografts favoured for younger, active individuals and allografts often recommended for older or less active patients.

Experienced Orthopaedic Surgeons For ACL Reconstruction

More Than 20 Years of Clinical Experience

Double Fellowship Trained Surgeons for ACL Surgery Singapore

Dr Tan Sok Chuen

Orthopaedic Surgery Specialist

Dr. Tan is an orthopaedic doctor with subspecialty training in hip and knee surgery – making her the first female hip and knee replacement surgeon in Singapore

Dr Adrian Lau

Orthopaedic Surgery Specialist

Dr. Adrian Lau is a specialist orthopaedic surgeon trained in primary and complex hip and knee arthroplasty. He was awarded the Ministry of Health Training Award in 2014.

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Address
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Mount Elizabeth Novena Specialist Centre,
#09-21/38, Singapore 329563

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