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The anterior cruciate ligament (ACL) plays a critical role in stabilising the knee. Injuries to the ACL are common, especially among athletes and active individuals, and often require surgical intervention. If you are considering or scheduled for ACL reconstruction, this guide will help you understand what to expect before, during, and after the procedure, as well as tips for a smooth recovery.

Understanding ACL Reconstruction Surgery

ACL reconstruction is a surgical procedure to replace a torn ACL with a graft, typically taken from the patient’s hamstring, patellar tendon, quadriceps tendon or a donor tendon (usually tibialis anterior tendon, achilles tendon or bone-patella-bone tendon). The procedure is typically performed arthroscopically, which means it is minimally invasive, using small incisions and a camera to guide the surgeon.

  • Who Needs It?
    Surgery is often recommended for individuals with severe ACL tears, especially if they are physically active or experience knee instability that affects daily life.
  • Preparation for Surgery:
    Before the operation, your doctor may advise physical therapy to reduce swelling and improve range of motion. Achieving full knee extension pre-surgery can enhance recovery outcomes.

The Surgery Process

  1. Anesthesia: General or regional anesthesia is administered to ensure comfort.
  2. Arthroscopy: Small incisions are made, and a camera is inserted to guide the surgeon.
  3. Graft Harvesting: If using your tissue, the graft is taken from your hamstring or patellar tendon.
  4. Reconstruction: The torn ACL is replaced with the graft, secured using screws or other fixation devices.
  5. Closure: Incisions are closed with sutures, and the knee is bandaged.

Meniscus tears can occur together with ACL tears. The meniscus injuries will be treated at the same time as the ACL reconstruction.

The procedure typically lasts 1-2 hours, and most patients go home the same day.

Recovery Timeline

Recovery from ACL reconstruction is a gradual process that requires commitment to physical therapy and adherence to medical advice. Here’s a general timeline:

  • First Week Post-Surgery:
    • Rest, ice, compression, and elevation (RICE) to manage swelling.
    • Use crutches to minimise weight-bearing on the affected leg.
    • Start gentle exercises to regain motion, such as bending and straightening the knee.
    • I routinely see my patient in the clinic at 3 to 4 days post-surgery. This is because the operated knee tends to swell up due to post-surgery knee haemarthrosis (blood in knee joint) and this can be relieved with a simple needle knee aspiration. 
  • 2-6 Weeks:
    • Begin physical therapy focused on improving range of motion and strengthening surrounding muscles.
    • Gradually reduce reliance on crutches.
    • Engage in light exercises like stationary cycling.
  • 3-6 Months:
    • Build strength and balance through targeted exercises.
    • Progress to activities that mimic daily movements.
    • Some may begin light jogging or sports-specific drills under supervision.
  • 6-12 Months:
    • Full return to high-impact sports is typically allowed after 9-12 months, depending on recovery progress and medical clearance.

Key Tips for a Successful Recovery

  • Commit to Physical Therapy: It’s crucial for restoring knee strength and stability.
  • Follow Your Surgeon’s Advice: Avoid overexertion to prevent complications.
  • Stay Positive: Recovery can feel slow, but patience and consistency yield the best results.
  • Monitor for Red Flags: Report symptoms like excessive swelling, persistent pain, or signs of infection to your doctor.

What to Expect Long-Term

Most individuals regain full knee function and return to their pre-injury activities. However, recovery varies, and some may experience occasional stiffness or discomfort. Adopting a fitness routine that strengthens your lower body can help maintain knee health.

Final Thoughts

ACL reconstruction is a life-changing procedure for many, offering the chance to regain stability, mobility, and confidence. By understanding what to expect and actively participating in your recovery, you can set yourself up for success. Remember, every journey is unique, so listen to your body and work closely with your healthcare team.

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