ACL reconstruction is a surgical procedure that replaces the ACL (Anterior Cruciate Ligament), one of the main ligaments in the knee, with a tissue graft. An ACL reconstruction is done when an ACL tear or rupture occurs.Enquire Now
The ACL is a strong, dense tissue band that runs diagonally across the knee, providing it with structural support. It is especially important when making sudden changes in direction, such as pivoting and side-stepping, as it prevents the knee from rotating excessively.
An ACL is more likely to get torn when performing intense activities that require a lot of changes in direction (e.g. sports like basketball and football) and the knee twists unexpectedly. A ‘pop’ sound is usually heard and that is often an indication of a torn ACL. Other symptoms of a torn ACL include the knee joint becoming swollen and tender to the touch.
The orthopaedic surgeon will first assess the extent of the tear using an MRI (Magnetic Resonance Imaging) machine. If the tear is partial and there is little indication of instability, physical therapy is typically prescribed. ACL reconstruction is recommended for active adult patients involved in sports or jobs that require pivoting, turning, or hard-cutting, as well as heavy manual work. Surgery is also recommended for ACL tears that are also associated with another ligament injury, or the injury is causing the knee to buckle when doing daily activities.
Do note that an ACL tear cannot heal on its own. Thus, it is very important to consult a doctor immediately if you suspect that you might have sustained an ACL tear so that you can get it treated properly.
The goal of ACL reconstruction is to restore stability to your knee so that you can carry out daily activities properly, and without injuring the other structures of the knee for example meniscus or cartilage. For athletes, undergoing ACL reconstruction also helps reduce the risk of getting post-traumatic arthritis.
If you have decided to have an ACL reconstruction, you still need to undergo physical therapy in the time following up to the surgery. This is because patients who have a swollen knee lacking full range of motion at the time of the surgery face significant issues regaining movement after surgery. As such, physical therapy before surgery helps to reduce the swelling, strengthen your muscles and restore movement so that recovery will be easier.
You will be given an anesthetic and when it has taken effect, the doctor will make 2 small stab incisions at the front of the knee to remove the damaged ligament. A tendon, known as a graft, is either harvested from another region of the knee or taken from a donor and used to replace the damaged ligament. The tendon may be taken from the following locations:
You can also refer to the video above for a more detailed overview of the surgery.
Some pain is expected after surgery and the doctor may prescribe pain medications to help ease the pain. Most patients can usually walk around a few hours after surgery with the help of crutches and are typically discharged within the same day. The surgical wounds should be kept clean and dry for two weeks so that they can heal properly.
The most important part of the recovery process after ACL reconstruction is physical therapy and rehabilitation.
Most of the time, physical therapy starts the day/the same afternoon after surgery and with consistent exercises, patients can straighten their knee and restore strength to their knee. Rehabilitation of the knee aims to reduce the swelling, maintain mobility and reduce knee pain problems. With regular rehabilitation, patients should regain the full range of movement as well as strength to the muscles.
Sense of balance and control of the knee should also be restored, and that usually takes 4-6 months. If you are an athlete, it is highly likely that you may only return to competitive play after 9 to 12 months.
For others, they typically can resume office-based work within 2 weeks while physically demanding occupations may require a longer rest period.
ACL reconstruction is generally a safe procedure and the risk for major complications is less than 1%. For ACL reconstruction, common complications include:
Your doctor will thoroughly discuss the risks of ACL reconstruction with you and outline the necessary precautions that they will take to minimise the chances of complications occurring.
Dr Tan Sok Chuen is an orthopaedic surgery specialist with subspecialty training in hip and knee surgery – making her the first female hip and knee replacement surgeon in Singapore. She has trained and educated junior doctors through various teaching programmes and courses. Dr Tan has also made many contributions to the scientific literature on hip and knee arthroplasty and her publications on trunnionosis in hip replacements are frequently quoted in indexed journals.
Dr Adrian Lau is a specialist orthopaedic surgeon trained in primary and complex hip and knee arthroplasty. His clinical practice comprises mainly of total knee replacements, total hip replacements, complex hip and knee replacements, revision surgeries, prosthetic joint infections, and periprosthetic fractures. Dr Lau also plays an active role in the education and training of junior doctors and is a recipient of numerous awards, one of them being the Ministry of Health Training Award in 2014.
Our doctors are trained and highly experienced in diagnosing and treating orthopaedic conditions of the knee. We aim to provide you with quality care by thoroughly assessing your condition and personalising your treatments to your needs and goals.