Anterior Cruciate Ligament Surgery

Summary of anterior cruciate ligament surgery

The ACL, anterior cruciate ligament, binds the base of the thigh bone with the top of the shin bone and is located within the knee joint. Though in some minor cases home exercises can be enough to allow a relatively normal movement, surgical intervention is necessary in many cases when the extent of the damage and the patient’s lifestyle require a full recovery. Following the surgery, rehabilitation is delivered at different stages to allow the knee to strengthen and stabilise. This is achieved over the process of between 4 and 12 months, depending on the surgeon. A home exercise program follows to ensure the knee joint continues to become strong.

Anterior Cruciate Ligament surgery FAQ's

What is Anterior Cruciate Ligament surgery

ACL reconstruction surgery is required when the ligament becomes so overstretched that the injury and inflammation has rendered the patient too unstable for home treatment. Between 70 and 90% of ACL injuries are managed with surgical intervention. Most surgeons prescribe a set of exercises to engage in before surgery, to ensure that the knee has as much free movement as possible and that the thigh muscles are as strong as possible. The current surgical procedure replaces the original ACL with a graft from the patients own local tendons, usually the hamstring or patellar tendon. This is usually achieved with keyhole surgery, designed to be as minimally invasive as possible, allowing quick recovery and rehabilitation and minimising the potential pain and swelling. Most patients are able to fully return to sports following this surgery.

What happens immediately after the surgery?

The surgery takes between 2 and 4 hours, and you will be seen by a physiotherapist shortly after the surgery has been completed. You may be given a mechanical device to assist in continuous passive movement, moving your knee for you; though sometimes this is replaced by exercises you must carry out yourself. Either way, it is vital to move the knee as soon after surgery as possible. Patients are usually able to stand and walk about gently 24 hours after surgery, and will be discharged from hospital between 2 and 3 days after surgery. A supporting knee brace is advised for the first 4-6 weeks, to control how much you can straighten the knee when weight bearing and to encourage full knee extension.

Rehabilitation following anterior cruciate ligament surgery

You should be given an exercise program before leaving the hospital, advising you of the correct rehabilitation protocol. A physiotherapist will want to meet with you following the surgery and you will be asked to attend outpatient appointments twice or three times a week for up to six weeks. Physiotherapy will initially be directed towards managing and controlling the pain and swelling of the knee area, working up towards regaining a full range of knee motion within 6 weeks. The physiotherapist will talk you through closed chain exercises, where the foot of the affected knee is kept on the floor and you engage only your leg muscles, for example lunges and knee dips. This is said to take greater strain away from the ACL. Gentle sports will be recommended at first, introducing activities as time passes. If you are unsure which activities and sports you should and should not engage in, always check with the surgeon or physiotherapist

Returning to normal activities

It can take between 6 and 12 months for your knee to fully recover its full range of motion and function, though this depends on the individual. Please note you should not drive until you can perform an emergency stop comfortably.

Why is it important for me to do the prescribed exercises?

Following the exercises properly will ensure that the surgical graft is put through the correct degree of strain at the correct time. This means you need to be aware of what needs to be done and at which stage of the healing process.