The anterior cruciate ligament (ACL) is a ligament in the middle of your knee that connects the front of shin bone thigh bones to the back of your thigh bone and helps to stabilise the knee. Tears (or ruptures) to this ligament can occur when making sharp twists and turns, causing the knee to ‘give way’ or collapse. An ACL repair stitches the damaged ligament back together.
ACL repair versus reconstruction: which is right for me?
While ACL reconstruction, replacing the damaged ligament completely, has long been the traditional treatment for ACL injuries, ACL repair is a relatively new procedure which involves keeping the existing ligament in place to promote self-healing, working to speed up recovery time. This would be particularly beneficial for those patients with more minor or partial tears, younger patients or those with newer injuries, however your surgeon will present both options and weigh up which would be best for you. If you do not lead an active life and your knee feels stable, you may be able to treat your ACL injury without surgery. However, non-surgical treatments are usually reserved for very minor tears.
Partial and complete ACL tears
ACL injuries can be graded on their severity, with grades 1 and 2 being the least severe, partial tears of your ACL and grade 3 being the worst, or a complete tear. If you have a partial tear, ACL repair may be offered as a treatment, however complete tears usually require a full ACL reconstruction.
Lifestyle factors in determining treatment
Multiple factors will go into determining treatment for your ACL injury.
If your knee feels stable and you do not lead an active life, you may decide not to opt for surgery. However, if it is very unstable, it would increase the risk of doing further damage during each episode when your knee gives way. The recovery can also be strenuous, so you will need to make sure you are able to keep up with the rehabilitation after any surgery takes place.
Damage to other areas of the knee can also occur with ACL injuries, so surgery may be needed to treat those as well as the ACL.
Your age may be a consideration as older people tend to be less active, so may not need surgery.
However, your consultant will advise you on the best course of action.
How soon should you get ACL repair treatment?
You should consult doctors as soon as you injure your knee, however before any treatment can be considered, you must wait for any swelling to disappear and for a full range of movement to return to the joint.
To aid recovery, you may also be asked to ensure your thigh and hamstring muscles are as strong as possible before having surgery, and you may be referred for physiotherapy to do this (this is commonly called ACL prehabilitation or ‘prehab’. The physiotherapists will provide you with stretching exercises and low-impact movements to aid in your preparation for surgery.
By doing this, you can expect to be ready for any surgery in 3-6 weeks.
What does ACL repair involve?
For very minor tears, your doctor may suggest non-surgical treatment. The use of ice to reduce swelling and reducing or stopping any activity for a few weeks will aid healing. You may also be asked to strengthen the muscles around your knee joint to such a level in order to counteract any instability that you may have. This will be done with a thorough physiotherapy programme.
However, ACL repair usually requires surgery, which is performed under general anaesthetic and by ‘keyhole’ surgery, or arthroscopy, using a small camera to see inside the knee. Your surgeon will repair the damaged ligament using strong stitches, then anchor the repaired ligament into the thigh and shin bones using special screws that are inserted into ‘tunnels’ drilled in the bones.
Potential complications of ACL repair
As with any surgery, there can be complications. General complications can be:
Blood clots (DVT)
Specific complications with ACL repair:
As ACL repair is a less invasive form of treatment for ACL injuries, some of these complications will be less likely, and the likelihood of a recurrence of the injury may be less.
ACL repair recovery
How long does it take to walk after ACL repair?
Immediately after your surgery, you will be given light exercises that you can start in the hospital and continue at home. These will help you back on to your feet, and you will be given crutches to help you.
You can expect to need crutches for around 1-2 weeks before you will be able to walk unaided, but you should only dispense with them if you feel able to safely control your knee.
Most people make a good recovery from ACL repair surgery and return to normal activities. You will be given a structured rehabilitation schedule to follow which will be split into phases.
These phases will be similar for an ACL reconstruction, however with a repair, you may discover that you progress quicker, but of course, recovery will vary from person to person.
You should be able to go home the same day after your surgery. The first phase of recovery will be similar to your pre-surgery preparation and aim to dispel any swelling around the knee as well as regain range of movement and strength of the muscles around the knee joint. You will also be given crutches to help with getting around to begin with.
This is likely to take between 4 and 8 weeks. Your surgeon will need to check on your recovery to ensure that the knee has regained movement and has settled down sufficiently.
The second phase of recovery has the aim to return to light exercise and sporting activities. Your surgeon and physiotherapist may suggest limiting bending your knee to around 90 degrees in this phase, so activities such as stationary bikes or swimming, to limit any twisting and turning for the knee, will be advised.
This phase will take between 8 weeks to six months.
The final phase of treatment will look to get you back to the levels of exercise and sport you were at before your injury, by gradually introducing twisting and turning back into your activities.
Depending on the level of sport you take part in, this may take 6-9 months. It may also take you longer to regain confidence in your knee, so only participate in activities when you feel comfortable, and when your recovery team is happy with your progress.
Pain during recovery
As with any surgery, there may be some pain when you are recovering. You may experience some bruising, swelling and discomfort in the knee joint after your treatment, but this can be managed with painkillers. These symptoms are likely to last for around 1-2 weeks after surgery.
You may experience stiffness and swelling from time to time throughout your recovery, however this will lessen as time goes by. If the symptoms are persistent, contact your doctor who will be able to advise the best course of action.
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