The knee is one of the largest and most complex joints in the body. The knee is made up of bones, cartilage, ligaments, and tendons. The knee joins the thigh bone (femur), the shin bone (tibia), the smaller bone that runs alongside the tibia (fibula) and the kneecap (patella) altogether to make up the knee joint. The knee is a synovial joint, meaning it contains a fluid-filled capsule.
Tendons connect the knee bones to the leg muscles that move the knee joint, and ligaments join the knee bones and provide stability to the knee.
WHAT IS ACL RECONSTRUCTION?
ACL reconstruction is a procedure that involves replacing a torn anterior cruciate ligament (ACL) — a major ligament in your knee. The ACL is a band of tissue in the knee, that helps to hold the bones of your knee together, keeping your knee stable. If the ACL gets damaged, you may have trouble putting pressure on your knee, walking, or playing sports.
WHAT ARE THE SYMPTOMS OF AN ACL INJURY?
Symptoms of an ACL injury include:
- A popping sensation in the knee
- Feeling of knee instability
- Loss of motion
- Severe pain and unable to continue activity
WHAT ARE THE CAUSES AND RISK FACTORS OF AN ACL INJURY?
ACL injuries often occur during sports activities. The main causes include:
- Landing awkwardly from a jump
- Sudden change in direction
- Sudden stopping from quick movement
- Receiving a direct blow to the knee, such as during a collision or when being tackled
- Pivoting on a foot that has been planted to the ground
Risk factors of an ACL injury include:
- Gender (females are more likely to sustain an ACL injury due to bone structure and muscle strength)
- Type of sport (certain sports have a higher chance of sustaining an ACL injury such as skiing, football and gymnastics)
- Footwear (inappropriate footwear or ones that do not fit properly increase your risk)
- Poor conditioning
- Sports equipment- using poorly maintained sports equipment increase your risk
PREPARING FOR AN ACL RECONSTRUCTION SURGERY
Before your surgery, you will need to undergo several weeks of physiotherapy. The main aim is to reduce pain and swelling, restore full range of motion in your knee and strengthen the muscles. This is because people who go into surgery with a stiff, swollen knee may not regain full range of motion after surgery.
As ACL reconstruction is an outpatient procedure, you will be able to go home on the same day. Arrange for someone to drive you home.
It is also important to inform your doctor on the type of medications and dietary supplements you take, if any. If you regularly take blood-thinning medications, your doctor may ask you to stop taking these at least 1 week before surgery, to reduce your risk of bleeding.
WHAT HAPPENS DURING AN ACL RECONSTRUCTION SURGERY?
During ACL reconstruction, the torn ligament is removed and replaced with a part of a tendon. This replacement tissue is known as a graft, and the graft tendon is either taken from another part of your knee or from a deceased donor.
Two holes called “tunnels” will be drilled into your thighbone and shinbone to accurately position the graft, which is then secured to your bones with screws or other devices. The graft will serve as a bridge on which new ligament can grow.
WHAT ARE THE RISKS AND COMPLICATIONS OF AN ACL RECONSTRUCTION SURGERY?
As with any type of surgery, there are risks accompanied. These include:
- Knee pain
- Knee stiffness
- Failure / loosening of the graft
WHAT HAPPENS AFTER AN ACL RECONSTRUCTION SURGERY?
Upon recovering from the anaesthesia, you may go home on the same day. Before you leave, your doctor will get you to practice moving around with crutches, and you may even be asked to wear a knee brace / splint to protect the graft.
Specific instructions on how to manage the pain and swelling after surgery, such as keeping the leg elevated will be conveyed to you before you leave. Over-the-counter medications such as acetaminophen will be prescribed to help with the pain as well.
Physiotherapy may also be recommended to help strengthen knee muscles and progressively regain your range of motion after the surgery. Successful ACL reconstruction together with focused rehabilitation typically restores stability and function to your knee. Within the first few weeks after surgery, you should strive to regain a range of motion equal to that of your opposite knee.
Recovery generally takes about nine months, and may take eight to 12 months or more before athletes can return to their sports.