ACL Reconstruction Surgery

What is ACL reconstruction surgery?

ACL reconstruction surgery This surgery is designed to correct a torn anterior cruciate ligament. The anterior cruciate ligament (ACL) is one of the important ligaments that stabilise your knee joint (see figure 1). If you have torn (ruptured) this ligament, the knee can collapse or ‘give way’ when making twisting or turning movements.

How does an ACL rupture happen?

An ACL rupture happens as a result of a twisting injury to the knee. It can be injured if you are changing direction rapidly, landing from a jump incorrectly, stopping suddenly or having a direct collision. The ligament tear is common sports injuries usually happening whilst playing sports such as football, rugby, tennis or skiing. You can injure other parts of your knee at the same time, such as tearing a cartilage or damaging the joint surface.

What are the symptoms?

You might have injured your anterior cruciate ligament if you experience the following:     

  • Hearing a loud “pop” in the knee and experiencing severe pain afterwards
  • Pain and swelling
  • Difficulty walking
  • Loss of full range of movement
  • Difficulty straightening the knee 

How is ACL diagnosed?

Your consultant will examine your injured knee and assess the damage. He or she will assess the knee thoroughly and may also use X-rays or an MRI to confirm an ACL diagnosis. 

What are the benefits of ACL reconstruction surgery?

If your ACL reconstruction surgery is successful, your knee should not give way any more. This will allow you to be more active and return to some or all of your sporting activities.

What will happen during my ACL reconstruction consultation?

The consultant will perform a physical examination of your injured knee, comparing it with the healthy one.

When you meet with your consultant surgeon they'll ensure that you have the opportunity to ask any questions you may have about your ACL reconstruction, they'll discuss with you what'll happen before, during and after the procedure and any pain you might have. Take this time with your consultant surgeon to ensure your mind is put at rest.

Are there any alternatives to surgery?

Having physiotherapy can strengthen and improve the coordination of the muscles in your thigh. This can often stop your knee giving way during everyday activities. Wearing a knee brace can sometimes help during sports activities.

Having surgery depends on the level of damage to your knee and how it affects your life. If you have active lifestyle then it’s best not to delay surgery as it could result in further damage in your knee. 

What does the operation involve?

A variety of anaesthetic techniques are possible: you can have a general anaesthesia and be unconscious throughout the operation, or a spinal anaesthetic that will numb your lower body.

The ACL reconstruction surgery usually takes between an hour and an hour and a half.

Your surgeon will make one or more cuts on the front and sides of your knee. Some surgeons perform the operation by arthroscopy (‘keyhole’ surgery) using a camera to see inside the knee.

Your surgeon will replace the ACL with a piece of suitable tissue (a graft) from elsewhere in the body. The top and bottom ends of the replacement ligament are fixed with special screws or anchors into ‘tunnels’ drilled in the bone.

What complications can happen?

All surgeries have a certain risks such as:

  • Pain
  • Bleeding
  • Infection in the surgical wound
  • Unsightly scarring
  • Blood clots
  • Difficulty passing urine

Knee surgeries have the risks of:

  • Break of the kneecap
  • Damage to nerves around the knee
  • Infection in the knee joint
  • Discomfort in the front of the knee
  • Loss of knee movement
  • Recurrent giving way of the knee
  • Severe pain, stiffness and loss of use of the knee (Complex Regional Pain Syndrome)

How soon will I recover?

Depending on your overall health, age and extent of the damage, you might be able to go home the same day or spend the night in a ward.

The consultant may ask you to wear a knee brace for the following weeks. Once the knee is settling down you will need to start intensive physiotherapy (link) treatment which may continue for as long as six months.

Regular exercise should help you to return to normal activities as soon as possible.  A physiotherapist will advise on what kind of exercises you should do for recovery. It is unlikely that your knee will ever be quite as good as it was before the original injury.

Paying for your operation

ACL reconstruction surgery costs are covered by most medical insurance policies, but please check with your insurer first. If you are paying for your own treatment the cost of the operation will be explained and confirmed in writing when you book the operation. Ask the hospital for a quote beforehand, and ensure that this includes the surgeon’s fee, the anaesthetist’s fee and the hospital charge for your procedure.

*Revised and updated November 2016

Pricing

Knee ligament repair (ACL)

Patient pathway Initial consultation Diagnostic investigations Main treatment Post discharge care Total
Hospital fees N/A Included £6,262 Included £6,262
Consultants fees £200 N/A Included Included £200
Total £6,462
Initial consultation
Hospital fees N/A
Consultants fees £200
Diagnostic investigations
Hospital fees Included
Consultants fees N/A
Main treatment
Hospital fees £6,262
Consultants fees Included
Post discharge care
Hospital fees Included
Consultants fees Included
Total £6,462

Terms & Conditions

Treatment prices displayed are a guide for initial consultation, and a guide price for our fixed price packages which include pre-assessment, procedure and aftercare. Your Consultant will be able to discuss costs in greater detail at your consultation, after which a quote of your fixed price package will be provided [which is subject to results of any pre-assessment tests]. Prices can be subject to change.

For more information please refer to our terms and conditions (large print version).

Anterior Cruciate Ligament Q&A with Mr Deepu Sethi

Anterior Cruciate Ligament (ACL) injuries of the knee.

Most commonly there is a non-contact pivoting or twisting injury to the knee. The player often falls to the ground and is unable to continue playing. Patients often describe hearing a "pop" in their knee. Very soon after the injury there is significant swelling, which is accompanied by knee pain.

Whilst most patients are men, women are statistically more likely to sustain an ACL injury. This difference is largely due to a number of anatomical differences between men and women.

They must seek medical help soon. The priority in the days following the injury is to reduce the swelling in the knee, regain a full range of motion and retain the strength of muscles around the knee. Early physiotherapy input is essential.

An experienced surgeon would make a diagnosis from the patient's history and by examining the patient. A MRI scan would often be done to confirm the diagnosis and ascertain if there are any other associated injuries.

Early physiotherapy and rehabilitation is essential for all patients. For patients with persistent symptoms of instability and for those who want to return to pivoting sports (such as football), surgery is often required.

An ACL reconstruction has the best track record of allowing patients to return to sports and stopping instability of the knee. During this operation a tendon from the patient is taken and used to reconstruct and make a new cruciate ligament.

More novel techniques are emerging where the old torn ACL is repaired (instead of being reconstructed) – we do not have long term data for these procedures, but in the future we may be doing more ACL repairs rather than reconstructions – watch this space!

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