Understanding anterior cruciate ligament (ACL) injury
An anterior cruciate ligament injury may lead to ongoing instability and symptoms such as a knee ‘giving way’. Surgery is not required for all ACL injuries. Some patients may choose to modify their activities and lifestyle to avoid further knee injury and giving way episodes. Non-operative treatment may help to strengthen and stabilise the knee.
Non-operative or ‘conservative’ treatment may involve a physiotherapy programme to help rehabilitate the knee.
Strengthening exercises aim to build up other supporting muscles around the knee in an attempt to compensate for the deficient ACL. Once the power of the muscles has been restored balance and ‘proprioception’ exercises are commenced. Proprioception exercises help to retrain positional sense and reflex pathways in the knee to try and prevent further instability.
Specially designed ACL knee braces can be used to provide extra support to the knee. These braces tend to be rather large and bulky and are often not well tolerated for long-term use. Specialist advice is advised before investing in an ACL brace.
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.
Pricing
| Initial consultation | From: £150 |
| Treatment | £7,440 |
| Pre-assessment | Included |
| Main treatment | Included |
| Post-discharge care | Included |
| Guide price | £7,590 |
*The above prices are guide prices only and subject to change at any given time. Diagnostic scans and investigations are not part of the guide price. The guide price indicates the starting price for the treatment.
The cost of treatment will be made clear to you before you proceed with any tests, scans, consultations, or treatment. Please read our terms and conditions. If you have private medical insurance please follow the guidance here.
