An ACL (anterior cruciate ligament) injury is a common knee injury, often occurring during sports activities that involve sudden stops, changes in direction, or jumping.
As an orthopaedic surgeon, I can provide you with a general guide on ACL injuries, including their causes, symptoms, diagnosis, treatment options, and recovery process.
However, please note that this information is not a substitute for professional medical advice, and it’s important to consult with a qualified healthcare provider for a proper evaluation and personalised treatment plan.
Causes of ACL Injuries
- Sudden stops or changes in direction: These movements can place excessive stress on the knee joint, leading to ACL tears.
- Landing improperly: Incorrect landing after a jump can cause the knee to buckle, resulting in an ACL injury.
- Direct impact: A forceful blow to the knee, such as a collision during sports, can cause ACL tears.
- Twisting of the knee: Twisting or pivoting motions, especially when the foot is firmly planted, can damage the ACL.
Symptoms of ACL Injuries
- Audible “popping” sound at the time of injury.
- Severe pain in the knee.
- Rapid swelling within a few hours of the injury.
- Limited range of motion and difficulty walking or bearing weight on the affected leg.
- Feeling of knee instability, as if the knee is giving way.
A story of pivoting injury with “pop” sound, immediate swelling and pain in the affected knee and inability to continue playing the game gives me 70% confidence that the diagnosis is an ACL tear.
Diagnosis of ACL Injuries
To diagnose an ACL injury, an orthopaedic surgeon may perform the following:
- Physical examination: The surgeon will assess the knee’s stability, range of motion, and look for signs of swelling or tenderness.The common physical examination tests for ACL tear are:
- Anterior drawer test.
- Lachman’s test.
- Pivot shift test.
- Imaging tests: X-rays can help rule out other bone injuries, while MRI (magnetic resonance imaging) provides detailed images of the knee structures, including the ACL, to confirm the diagnosis and to look for associated injuries such as a meniscus tear or cartilage tear or tear of other ligaments of the knee.
- Rehabilitation exercises: Strengthening the muscles around the knee to provide stability and support.
- Physical therapy: Focused on improving range of motion, reducing swelling, and restoring knee function.
- Bracing: A knee brace may be used to provide additional support during activities.
ACL reconstruction: This procedure is typically recommended for active individuals or athletes.
The torn ACL is replaced with a graft, usually taken from the patient’s hamstring tendon or a donor tendon. Other graft options include quadriceps tendon, bone-patellar-tendon-bone and peroneal tendon.
The ACL reconstruction is done via arthroscopic surgery. This is a minimally invasive surgery performed using small incisions and a camera to guide the surgeon. It allows for better visualisation and quicker recovery.
The patient usually stays in the hospital overnight after the surgery. Some patients prefer to do the surgery and go home on the same day. The patient is allowed to walk full weight bearing on the operated leg after the surgery. Crutches are used when necessary. The crutches can usually be thrown away at 5 to 7 days post-surgery.
Rehabilitation: Physical therapy is essential to regain strength, flexibility, and stability. The recovery period can take several months.
ACL injury recovery is a gradual process that involves different stages:
- Early Stage: After surgery or injury, initial focus is on pain control, swelling reduction, and regaining range of motion.
- Intermediate Stage: Strengthening exercises, balance training, and gradual return to weight-bearing activities are introduced.
- Late Stage: Advanced exercises targeting agility, sport-specific movements, and functional training are incorporated.
- Return to Sports: Full recovery and return to sports activities typically take 9 to 18 months, depending on individual progress and surgeon’s guidance.
Gradual return to activities: It is crucial to follow the orthopaedic surgeon’s and physical therapist’s guidance when gradually reintroducing activities to prevent reinjury.
Follow-up visits: Regular follow-up visits with the orthopaedic surgeon will monitor progress and make any necessary adjustments to the treatment plan.
ACL Surgery Cost in Singapore
According to the Singapore Ministry of Health Website, the cost of ACL surgery in Singapore for Private Hospital as of June 2023 is:
ACL reconstruction SB800K, Table 5C: Total Bill Amount range from $24,925 to $33,288.
ACL reconstruction with meniscus repair SB703K, Table 5C: Total Bill Amount range from $29,945 to $38,630.
This includes doctors’ fees, hospital’s charges and implants.