Do you suspect that you might have a torn ACL? It's important to understand the symptoms and seek immediate treatment, as a torn ACL cannot heal on its own. Explore our advanced surgical treatment options to regain strength and confidently return to your active lifestyle.
Due to its limited capacity for self-repair, surgical treatment is often necessary to restore ACL integrity. ACL reconstruction surgery commonly involves grafting tissue from the patient’s body or a donor source to reconstruct the torn ligament, aiming to reinstate knee stability and function.
The anterior cruciate ligament (ACL) is a crucial ligament in the knee joint, running diagonally through the centre. It plays a vital role in stabilising the knee by connecting the thigh bone (femur) to the shin bone (tibia), regulating movement and alignment.
• Stability Assurance: The ACL is pivotal in maintaining knee stability, especially during dynamic activities such as running and abrupt changes in direction. It limits excessive forward movement of the shin bone relative to the thigh bone, safeguarding against potential injury 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 knee 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.
An ACL tear can significantly impair knee joint function, leading to knee instability and increased vulnerability to further damage. Symptoms typically include knee pain, swelling, instability, and occasionally a noticeable popping sensation upon injury.
ACL injuries are prevalent among athletes and individuals leading active lives, resulting from various activities and 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 anterior cruciate ligament, increasing vulnerability to injury.
• Sudden Stops: Abrupt halts in motion, characteristic of many sports manoeuvres, may subject the ACL to undue stress, precipitating injury.
• 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.
• A substantial portion of ACL injuries occurs without direct contact, often during movements such as sharp pivots or awkward landings. This underscores the importance of mastering proper biomechanics and maintaining optimal physical conditioning.
• 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 altered stress distributions across the knees.
• Inability to sustain physical activity or sports participation post-injury.
Contact us promptly if you experience any of these symptoms following a knee injury.
Early recognition of ACL injury symptoms is paramount for timely intervention and effective management. Key indicators include:
• Rapid onset, typically within 24 hours post-injury.
• Observable swelling around the knee joint.
• Acute pain at the moment of injury.
• Exacerbation of pain with weight-bearing activities.
• Deep-seated or anterior knee pain.
• Sensation of knee instability or giving way.
• Lack of confidence in weight-bearing activities.
• Difficulty in fully extending or flexing the knee.
• Impaired movement due to pain or swelling.
• Perception of a distinct “pop” at the time of injury, although not universally experienced.
• Tenderness along the sides of the knee joint upon palpation.
ACL tears typically do not heal on their own due to their position within the knee and the interference of synovial fluid, which hampers the natural healing process of the ligament. Therefore, for individuals with a complete ACL tear, especially those engaged in sports, ACL reconstruction surgery is often the recommended path.
Hip & Knee Orthopaedics in Singapore specialises in both the surgical treatment and rehabilitation necessary to expedite your return to an active lifestyle. It’s crucial to consult with a specialist for individualised advice. A deep understanding of the ACL’s anatomy is essential for effective reconstruction surgery.
Our team frequently performs ACL reconstruction surgeries, and we are capable of offering guidance throughout your recovery journey.
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:
• Patient History Compilation: Gathering detailed information regarding the injury’s circumstances and immediate symptoms.
• Physical Examination: Thorough evaluation of the knee for indications of swelling, tenderness and stability, including specific tests like the Lachman test and anterior drawer test to assess ACL integrity.
• X-Rays: While not directly visualising soft tissues like the ACL, X-rays rule out bone fractures and assess overall knee joint alignment.
• Magnetic Resonance Imaging (MRI): 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 articular cartilage.
• In scenarios where diagnostic clarity remains elusive or for a nuanced evaluation of injury severity, arthroscopic intervention may be warranted. This minimally invasive surgery entails the insertion of a miniature camera into the knee joint, facilitating direct visualisation of the ACL and internal constituents for precise assessment.
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 three compartments of the knee is confirmed. The ACL tear is also confirmed.
Following the confirmation of the ACL tear, an autograft is harvested from one of three common areas: the hamstring tendons, the quadriceps tendon, or a bone-patella-bone graft from the patellar tendon. An incision is placed, and the autograft is taken. An allograft tissue 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 removes the old anterior cruciate ligament which has been detached. New femur and tibia bone tunnels are drilled, and the ACL graft is pulled through. The graft is then tensioned and fixed to either metal buttons on the femur/tibia side or screws. The knee is given a wash, and incisions are closed. The patient is usually given a hinged knee brace, and they start walking on the same day or the next day.
In most cases, patients undergoing ACL reconstruction surgery can anticipate a complete recovery and restoration of full knee joint function. The central variability lies in the pace of recovery:
We have assembled some packages to help our new patients.
Evaluation of Knee Pain with X-ray
• 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 9 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 knee stability compared to their pre-surgery condition.
Incorporate these practices to prevent anterior cruciate ligament injuries:
• Strength Training: Concentrate on building the strength of the muscles surrounding the knee, like the quadriceps and hamstring muscles. This will offer enhanced support for the knee 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.
Have questions? Our ACL specialists are available to provide professional guidance, empowering you with the information and confidence needed 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 R.I.C.E. 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 the 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 ACL reconstruction surgery typically ranges from a few thousand dollars to over $21,000, depending on factors such as the surgical technique used and whether the procedure is performed in a hospital or outpatient facility. Additional expenses may include anaesthesia, imaging, physical therapy, and follow-up care, which can significantly impact the total ACL surgery cost. Consult with your provider to understand what is included and what your insurance may cover.
Yes, ACL reconstruction is considered a major surgery. The surgical procedure involves replacing the torn anterior cruciate ligament with a graft—commonly a patellar tendon autograft or hamstring tendon autograft—depending on the patient’s individual needs and anatomy. Because the ACL plays a critical role in knee stability, often in conjunction with structures like the medial collateral ligament (MCL), restoring proper function through surgery is essential, especially for active individuals.
The best type of ACL surgery depends on several factors, including age, activity level, and the presence of any additional knee injuries such as a torn medial collateral ligament. For younger, athletic patients, a patellar tendon graft (often referred to as a patellar tendon autograft) is frequently preferred due to its high stability and success rate. Alternatively, a hamstring tendon autograft may be chosen for those seeking a less invasive harvest site with potentially less anterior knee pain. Allografts—tissue from a donor—may be more suitable for older or less active individuals.
Not necessarily, although the choice to have ACL reconstructive surgery depends on individual circumstances, such as the severity of the tear, activity level, and overall knee stability. Partial ACL tears or cases with low physical demands might be managed non-surgically through physical therapy and lifestyle adjustments. However, for active individuals—especially athletes—ACL reconstruction surgery is typically recommended to restore full knee stability and prevent further knee joint damage.
Surgery is usually performed after initial swelling and knee pain have subsided—typically within 3 to 6 weeks. Delaying surgery allows for better preoperative knee function, which can improve post-surgical outcomes. However, if knee instability is severe or if other injuries (like meniscus tears) are present, early intervention may be advised.
An ACL repair involves suturing the existing ligament together—this is rare and only suitable in specific cases, such as when the ligament tears directly off the bone. In contrast, ACL reconstruction surgery is more common and involves replacing the torn ligament with a tendon graft (from the hamstring muscles, patellar tendon, or donor tissue).
The ideal graft depends on your activity level, anatomy, and surgeon recommendation. Common options include:
• Hamstring Tendon Graft: Hamstring graft is considered less invasive and typically observes quicker recovery of knee extension.
• Patellar Tendon Graft: Strong and preferred by many athletes but may cause anterior knee pain.
• Quadriceps Tendon Graft: A good alternative, especially for revision surgeries.
• Allograft (Donor Tissue): Avoids harvest site discomfort but may have slightly higher re-tear risk in younger, active individuals.
While ACL reconstruction surgery significantly restores knee stability, preventing future injuries also relies on proper rehabilitation. Strength training, neuromuscular control exercises, and using hinged knee braces (if advised) can greatly reduce re-injury risk.
Most patients wear a hinged knee brace for approximately 4 to 6 weeks following ACL reconstruction surgery, particularly during walking and physical therapy. The brace helps protect the healing knee ligament by limiting excessive movement and providing external support. Maintaining controlled motion during this period is crucial for restoring knee range and promoting normal knee kinematics, both of which are essential for a successful ACL surgery outcome.
Yes, in most cases you can begin walking with crutches and a knee brace on the same or next day after surgery. However, full weight-bearing is typically gradual and guided by your surgeon and physiotherapist to avoid straining the new graft.
An untreated torn ACL can lead to persistent knee instability, which increases the risk of additional complications such as a cartilage injury or meniscus tear. This instability can also result in abnormal movement patterns, potentially causing kneecap pain and further stress on the surrounding structures.
Over time, untreated ACL tears may contribute to early-onset arthritis and chronic knee pain. For those with isolated ACL tears, non-surgical management may be considered, but for active individuals or athletes, early ACL reconstruction is often necessary to restore knee joint function and prevent long-term damage. Without intervention, the risk of severe cartilage injury increases, making it much harder to perform ACL reconstruction effectively later. In such cases, knee surgery becomes a critical step to not only repair the torn ligament but also to preserve the long-term health of the knee.
Read our article on Long-Term Effects of an ACL Injury Without ACL Tear Surgery or ACL Tear Treatment to learn more details.
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 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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Our doctors share their journeys as orthopaedic surgeons as well as offer insights and tips.