Have you injured your knee or have a long-term knee problem?
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Produced by Rebecca Canvin, Bupa Health Information Team, December 2011.
This factsheet is for people who are having anterior cruciate ligament (ACL) reconstruction, or who would like information about it.
An ACL reconstruction involves replacing the anterior cruciate ligament in your knee. This is done using a tendon from another part of your body. ACL reconstruction can improve the stability and the function of your knee, following an injury.
You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.
The ACL is a strong ligament that runs diagonally through the middle of your knee. It helps to keep your knee stable, especially when you turn, or when your knee joint moves from side to side.
The ACL is one of the most commonly injured ligaments. It's usually torn when you slow down very quickly while turning or sidestepping at the same time. You’re more likely to injure your ACL if you play sport, particularly basketball or football, and if you ski.
ACL reconstruction involves replacing your torn ligament with a graft. The graft is usually taken from a tendon in another part of your knee, but sometimes it can be a graft from a donor (an allograft). Your surgeon will discuss the different graft options with you.
ACL reconstruction is carried out to try to make your knee stable. This means that you may be able to return to playing sport, but that will depend on whether there are other problems with your knee such as torn cartilages, other ligament injuries or arthritis.
Some people with an ACL tear may not need an operation to repair it. You may be offered physiotherapy, exercises and a hinged knee brace to give your knee support. Your doctor may suggest this type of treatment if:
However, if your knee is unstable (gives way) and you want to return to playing sport, have an active job, or if you have other damage to your knee, then your surgeon is likely to suggest a reconstruction. If you’re at risk of osteoarthritis later in life, then your surgeon may also suggest reconstruction.
You will usually have ACL reconstruction between three and eight weeks after your injury. This allows any swelling to go down. Your surgeon may ask you to have physiotherapy during the weeks after your injury. This is to make sure you can move your knee as fully as possible before your operation.
Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
ACL reconstruction can be done using either local or general anaesthesia. A local anaesthetic completely blocks pain from your knee area and you will stay awake during the operation. If you have a general anaesthetic, it means you will be asleep during the procedure.
If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your anaesthetist’s advice.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
Your surgeon will examine your knee to check how badly your ligament is torn and whether any other tendons or ligaments have been damaged.
Your surgeon will make a number of small cuts in the skin over your knee that is being treated. He or she will insert an arthroscope and other surgical instruments into your knee through these cuts. An arthroscope has a thin, flexible tube with a light and camera on the end of it. It allows your surgeon to see inside your knee.
Your surgeon will remove the piece of tendon that will be used as the graft. He or she will usually take the graft from your patella tendon, which connects your kneecap and shin bone, or from one of your hamstring tendons at the back of your knee.
Your surgeon will drill a tunnel through your upper shin bone and lower thigh bone. He or she will put the graft into the tunnel, attach it to the bones and fix it in place, usually with screws. These are normally left inside your knee permanently. Your surgeon will close the cuts with stitches or adhesive strips.
The operation usually lasts between one and a half and two hours.
You may need to rest until the effects of the anaesthetic have passed.
You may need pain relief to help with any discomfort as the anaesthetic wears off.
After a local anaesthetic it may take several hours before the feeling comes back into your treated knee. Take special care not to bump or knock the area, and it is best to keep your leg elevated as much as possible.
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.
Dressings will cover the small wounds. You may also have a knee brace to give some support to your joint as it heals.
You will be encouraged to get up, put weight through your knee and move it as soon as you’re able to after your surgery. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours after your operation.
Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.
You will also see a physiotherapist who will give you some exercises to do while you recover. The amount of physiotherapy you need varies, so follow the advice of your physiotherapist and surgeon.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
You can also apply ice packs, for example, frozen peas wrapped in a towel, to your knee to help reduce any pain and swelling. Don't apply ice directly to your skin as it can damage your skin.
It usually takes about six months to make a full recovery from ACL reconstruction but this varies between individuals, so it's important to follow your surgeon's advice. If you have a desk job, you may be able to go back to work three to four weeks after your operation. It may take up to six months if you have an active job.
If you want to play sport after your operation, follow your surgeon’s advice about when it’s safe to do so. You may not be able to play some sports that involve lots of twisting and turning, for example basketball.
As with every procedure, there are some risks associated with ACL reconstruction. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.
After ACL reconstruction you may have side-effects, including:
Complications are when problems occur during or after the operation. Most people aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
The main complications of ACL reconstruction are listed below.
For answers to frequently asked questions on this topic, see FAQs.
For sources and links to further information, see Resources.
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This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.
Publication date: December 2011