ACL reconstruction surgery is often performed in cases where conservative management has failed or is unlikely to provide sufficient knee stability.

ACL reconstruction is the commonest ligament reconstruction performed in the knee.  It is a complex surgical procedure carried out to replace the torn ACL with an ‘artificial’ structure called a graft.

The most common types of graft used for this surgery are the ‘hamstring graft’ and the ‘patella tendon graft’. These grafts are taken from other parts of the knee during surgery and engineered to form a new ACL- type structure.  Other less commonly used grafts include the quadriceps tendon, processed allografts (from cadavers) and man-made synthetic grafts.  Each type of graft tissue has its own potential benefits and problems.  Generally hamstring and patella tendon grafts are considered to be the ‘gold standard’.

The surgery is usually performed arthroscopically and small incisions are used to harvest the graft used for the reconstruction.  The majority of reconstructions are performed as day case procedures, although occasionally an overnight stay is required.

It takes many months for the knee and new graft to build up strength after surgery and it is essential that sporting activities are not started too soon to help prevent re-rupture.

Physiotherapy advice and guidance is invaluable to guide the rehabilitation process.

What are the risks of ACL reconstruction?

As with every procedure, there are some risks associated with ACL reconstruction.  Your surgeon will discuss all risks with you and will be happy to answer any queries or concerns you may have.

Side-effects are the unwanted but mostly temporary effects you may experience post-operatively.

After ACL reconstruction you may experience:

• pain
• stiffness
• bruising and swelling.

Complications are when problems occur during or after the operation.  Most people aren't affected.  The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

The main complications of ACL reconstruction are:

• tearing of the new graft used to reconstruct the ACL
• numbness along the outside of your upper leg, near where the surgical cuts were made.  This may be permanent
• your knee joint may remain unstable.  This can happen if the tendon used as the graft tears or stretches
• stiffness in your knee, or less movement than you had before your injury
• long-term knee pain, or pain when you kneel down.

Minor injuries to those ligaments which support the knee are common.  This is usually in the form of a strain or sprain to the medial collateral ligament and can often be managed with ‘RICE’ or bracing. 

Occasionally a collateral ligament can be pulled from its attachment onto the bone and may get lodged within the knee.  This type of injury usually necessitates early repair.