ACL Reconstruction (ACLR) Surgery

What is ACL reconstruction surgery?

ACL reconstruction (ACLR) is a surgical procedure to repair/reconstruct a torn anterior cruciate ligament (ACL), which is one of the key ligaments in the knee joint. The ACL connects the femur (thigh bone) to the tibia (shin bone) and helps stabilise the knee, particularly during activities that involve pivoting, cutting, or jumping.

ACL reconstruction is the most effective way to restore knee stability and function after a complete ACL tear, especially for active individuals and athletes wanting to return to high-impact contact sports. If you're considering ACL surgery, consult with Dr Collins to discuss the best treatment options for your specific injury and activity level.

Why might I need ACL reconstruction surgery?

The ACL is often torn during sports or activities that require quick changes in direction, sudden stops, or twisting motions, such as in:

  • Football

  • Basketball

  • Soccer

  • Skiing

  • Tennis

A torn ACL can result in instability in the knee, making it difficult to participate in these activities. While minor ACL tears may heal with non-surgical treatments (like physical therapy), complete tears or tears in high-demand athletes or active individuals often require surgical reconstruction to restore knee function and stability.

Not all ACL injuries require surgery, and not all ACL injuries can or should be treated non-operatively.

If you’ve sustained an isolated ACL rupture/injury with associated chondral or meniscal injuries, a trial of non-operative treatment may be recommended. If you have ongoing instability and symptoms, ACL reconstructed may then be recommended.

If you’ve sustained associated chondral (cartilage) and meniscal injuries with your ACL rupture, Dr Collins will discuss with you the rationale and benefit for repairing/reconstructing your knee.

What are the symptoms of an ACL Injury?

  • Sudden, sharp pain: At the time of injury, many people report feeling or hearing a "pop" in the knee.

  • Instability: A feeling that the knee is "giving out" or unable to support weight, especially when changing directions or pivoting.

  • Swelling: Rapid swelling in the knee due to bleeding inside the joint.

  • Limited Range of Motion: The knee may become stiff, and it may be painful to fully bend or straighten the knee.

  • Difficulty Walking: Depending on the severity of the injury, it may be difficult or painful to walk without assistance.

What does an ACL reconstruction procedure involve?

The goal of ACL reconstruction is to replace the torn ligament with a graft (a piece of tissue) that will restore the knee’s stability and function. The procedure typically involves:

  1. Graft Selection: The first step in ACL reconstruction is choosing a graft to replace the damaged ligament. Dr Collins will discuss the options with you. These include:

    • Autograft: The graft is taken from the patient's own body, typically from the hamstring tendon, patellar tendon, or quadriceps tendon. Dr Collins regularly uses hamstrings and quadriceps tendon grafts.

    • Allograft: The graft is taken from a deceased donor, typically from the patellar tendon, Achilles tendon, or hamstring tendon. This is rarely necessary.

    • Synthetic Graft: In rare cases, a synthetic material may be used, but this is less common. Dr Collins does not recommened this.

  2. Surgical Procedure: ACL reconstruction is typically done using arthroscopy, a minimally invasive technique that involves making small incisions through which a camera (arthroscope) and surgical tools are inserted.

    • Dr Collins removes the damaged ACL remnants and prepares the bone for the new graft.

    • Small tunnels are drilled through the femur and tibia to accommodate the graft.

    • The graft is threaded through these tunnels and securely attached to the bone using fixation devices.

    • The incisions are closed, and the knee is bandaged.

  3. Additional procedures: Meniscal repair, chondral repair and LEAT (lateral extra-articular tenodesis) will be performed if required. A LEAT is a good option in patients at high-risk of re-rupture, this involves an additional soft-tissue procedure performed on the lateral/outside aspect of your knee to help lower the chances of re-rupturing your ACL.

The surgery usually takes 1 to 2 hours, depending on the complexity of the injury and the procedure.

What is the recovery like after an ACL reconstruction?

Recovery after ACL reconstruction is a gradual step-wise process best undertaken with the input and guidance of a specialist physiotherapist, typically involving the following stages:

  1. Initial Recovery (First Few Weeks):

    • Hospital Stay: ACL reconstruction patient will often go home within 24 hours, meaning you can go home the same day if well, you may need to stay in the hospital for a day or two in some cases.

    • Pain and Swelling Control: Pain management is important, and you will be advised to use ice, compression, and elevation to minimise swelling in the initial days.

    • Knee Brace and Crutches: You may be given crutches to assist with walking, and a knee brace might be used to support the knee during the early recovery phase.

  2. Physical Therapy: Physical therapy plays a key role in recovery. You will begin therapy shortly after surgery to improve range of motion, strength, and stability. The first phase focuses on gentle exercises to regain knee flexibility, while later phases involve strengthening the muscles around the knee, such as the quadriceps, hamstrings, and calf muscles.

  3. Return to Activity:

    • First 6 Weeks: In the first 6 weeks, you will focus on regaining mobility and strength in the knee, while also reducing swelling and pain.

    • 3 to 6 Months: By 3 to 6 months, you should be able to walk without crutches and may begin light physical activities.

    • 6 to 9 Months: As strength and stability improve, you may begin low-impact sports and exercises like cycling and swimming. Jumping, running, and pivoting may begin around the 6 to 9-month mark, depending on your progress and the surgeon's approval.

    • 9 to 12 Months: Full return to high-impact sports like basketball or soccer typically happens between 9 and 12 months, once the knee is fully healed and stable.

  4. Full Recovery:

    • Full recovery can take anywhere from 9 to 12 months or longer, depending on individual healing and rehabilitation progress.

    • Some patients may continue to experience mild swelling or discomfort for a few months, but this should improve over time with continued physical therapy.

What are the risks and complications of ACL surgery?

While ACL reconstruction is generally safe, like any surgery, it carries some risks including but not limited to:

  • Infection: Although rare, infections can occur after surgery.

  • Blood Clots: Deep vein thrombosis (DVT) or pulmonary embolus (PE) can develop, especially after knee surgery.

  • Graft Failure: The new ACL graft could fail to heal properly or tear again, especially if the knee is subjected to intense activity too soon.

  • Stiffness or Limited Motion: Some patients may experience persistent stiffness in the knee after surgery, early and sustained exercises with physiotherapy input is key to avoiding these issues.

  • Nerve or Blood Vessel Damage: The surgical procedure may cause injury to nerves or blood vessels near the knee.

  • Pain: Some patients experience ongoing pain or discomfort after the procedure, which may require further intervention.

Orthopaedic Surgeon Melbourne

Utilising the latest techniques and technology Kade aims to return you to your best as soon as possible with optimised recovery via a multi-disciplinary and multi-modal approach.