ACL Reconstruction

The Anterior Cruciate Ligament (ACL) is one of the major stabilizing ligaments in the knee. It is a strong rope like structure located in the centre of the knee running from the femur to the tibia. When this ligament tears unfortunately it doesn’t heal and often leads to the feeling of instability in the knee. ACL reconstruction is a commonly performed surgical procedure and with recent advances in arthroscopic surgery can now be performed with minimal incisions and low complication rates.

The ACL is the major stabilizing ligaments in the knee. It prevents the tibia (Shin bone) moving abnormally on the femur (thigh bone). When this abnormal movement occurs it is referred to as instability and the patient is aware this abnormal movement.

Often other structures such as the meniscus, the articular cartilage (lining the joint) or other ligaments can also be damaged at the same time as a cruciate injury & these may need to be addressed at the time of surgery.

History of Injury

  • Most injuries are sports related involving a twisting injury to the knee
  • It can occurs with a sudden change of direction, a direct blow e.g., a tackle, landing awkwardly
  • Often there is a popping sound when the ligament ruptures
  • Swelling usually occurs within hours
  • There is often the feeling of the knee popping out of joint
  • It is rare to be able to continue playing sport with the initial injury

Once the initial injury settles down the main symptom is instability or giving away of the knee. This usually occurs with running activities but can occur on simple walking or other activities of daily living.

What is ACL Reconstruction?

The Anterior Cruciate Ligament is the main ligament in your knee that makes it stable. When surgically repairing your ligament, your hamstring tendon (or sometimes patella tendon) is used to make a new ligament The ligament is fixed into the knee using titanium buttons buried under the skin.

 

Download the guidelines for prehabilitation before and rehabilitation after ACL Surgery.

 

ACL Reconstruction is used to replace a torn anterior cruciate.  This is a major ligament in your knee and damage is caused commonly in sports that involve changes in direction or suddenly stopping.  Surgical treatment of the ACL is considered crucial for knee function and to improve long term functionality and avoid more injuries and knee joint degeneration.

Surgery Information

Before the Surgery

Before surgery, the muscles around the knee should be strengthened as much as possible and the full movement gained to make recovery after operation as fast as possible. The exercises used to rehab the knee after surgery should be learnt and practised before surgery in the rehab programme.  This is where physiotherapy can help. Types of exercises your physiotherapist could advise are; hamstring curls, heel raises, heel slides, quad sets, shallow standing knee bends, glute sets, heel dig bridging and straight leg raise to the front.

After the Surgery

After the ACL surgery at the hospital, the physiotherapist will go over the exercises you should do at home and help you walk with crutches. Swelling of the knee can be expected in the first week. lt can be minimised by not doing too much walking. Driving a car in the first week is also prohibited. It is important during this early phase to reduce pain and swelling. It is recommended you modify your work/activity during this phase and elevate your leg as much as possible. Once you have minimal swelling, your rehabilitation program is concentrated on increasing the range of movement, strength, and full function.


Permanent stiffness of the knee can be avoided by pushing through some pain and moving the knee despite some pain. That way adhesions in the knee cannot form. (ie “No pain No gain”). But be sensible and don’t overdo this. The keyword here is balance – do too little and stiffness is lengthened, and normal mobility takes longer, do too much too soon, your knee will swell and hurt. Specialist visits will be at 2 weeks, 6 weeks, 3 months. For those wishing to return to sport then an ACL Re-injury Prevention test would be advisable. This is usually at about 10 months post-op.

 

Return to sport is usually between 10 – 12 months following surgery. Once the surgery is performed, your best results are achieved with physiotherapy and a rehabilitation program which will start after your first postoperative visit. In the initial phase following surgery, you will have pain, swelling, and loss of movement. You are usually on crutches for up to 2 weeks with weight-bearing permitted as soon as tolerated.

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