The anterior cruciate ligament (ACL) is a large ligament, about the thickness of your little finger, inside the knee.
The ACL is responsible for keeping the knee stable when performing cutting, twisting and turning movements. Occasionally, during sporting activities or falls, the force through the knee is too much for the ligament to withstand and it snaps. Other terms include ACL tear, ACL rupture or ACL strain. At the time of the injury, it’s common to sustain other injuries including meniscal (cartilage) tears and other ligament strains.
Unfortunately, the ACL does not heal, so the knee will remain unstable. This may be acceptable in activities of daily living, such as walking, but usually causes “giving way” of the knee during sport. Each episode of giving way causes some wear and tear of the knee, and may eventually lead to arthritis. Therefore, we most often recommend an ACL reconstruction.
ACL Reconstruction Surgery
The goal of ACL surgery is to restore joint anatomy, provide knee stability, and return to work and sport as soon as possible.
Some patients achieve satisfactory stability non-operatively. Long-term ACL deficiency may result in gradual damage to the menisci and articular cartilage.
ACL reconstruction is best performed once the knee has recovered from the initial injury, and full range of motion regained.
The following is a guide to the ACL surgery and the stages of rehabilitation after ACL reconstruction. The actual rehabilitation process will vary slightly from person to person, and also depend on any additional surgery performed.
Please do not shave your legs
Skin problems around the knee may cause a delay in surgery
Advise us of any known allergies
Bring any regular medications and all imaging performed to hospital
Upon admission, the nursing staff will explain the layout of the ward and prepare your knee for surgery
You will meet the anaesthetist and assistant surgeon prior to surgery
Your knee will be examines under general anaesthetic to re-assess the ligament’s instability. Your surgeon will perform a general arthroscopy to carefully examine the inside of your knee. Any cartilage tears or other damage inside the knee will be repaired during the ACL reconstruction operation.
The ACL reconstruction is performed with the arthroscope and usually takes about one hour. The damaged ligament is replaced by a graft; usually from the hamstring tendons (gracilis-semitendinosus) or middle third of patella tendon (bone-patella tendon-bone). The graft is passed through bone tunnels and fastened with screws or similar devices for fixation. The screws do not need to be removed.
Patients generally spend a night in hospital, followed by a period of rehabilitation to restore strength, motion, flexibility and proprioception.
The stages of rehabilitation are designed to reach the best compromise between biological healing and accelerated recovery. If at any stage, recovery is complicated by swelling or pain, then rehabilitation should be slowed to aid resolution.
ACL Post-Operative Recovery
THEME: REST. SWELLING, BRUISING CONTROL. PAIN CONTROL
Week 0 – 2 (approximate)
The aim of this stage is to recover after ACL surgery. You should spend the time at home resting. Stay mainly on the couch. Wear your tubigrip.
If you have any concerns about your wound or dressing, call the practice nurse on (03) 9417 7299 (Option 2)
DAY 1 & 2
The knee is braced initially in extension to allow healing around the graft at the bone tunnels
Regular ice to control swelling. Apply ice to your knee for 30mins, 5 or 6 times a day
Take pain killers as required. Stay well hydrated
Use crutches but weight bear as tolerated
Try to lock your knee out straight and tighten the quadriceps
Pump the calf muscles every chance you get
Maintain extension; pillow under heel NOT knee
Protected weight bearing (25-50%) for first 7-10 days
Static quadriceps contractions in extension; no active extension from 40 to 0 degrees allowed for 3 months
Patella mobilisation with quadriceps relaxed; glides and tilts
Opposite Leg Active Assist Leg Extension (OLAALE) for 6-12 weeks
Day 3 to 14
Proprioception; single leg stance 2 times a day for a few minutes, using hands for balance
Continued work on extension
(Prone knee hangs and knee flexion)
(Flexion exercises; prone / seated)
Your surgeon will see you two weeks after ACL surgery to check the wounds have healed properly, and direct your rehabilitation program.
DRIVING after acl reconstruction
Patients should wait 6 weeks before driving if their “braking” leg has undergone surgery
Read more about longer-term ACL rehabilitation including physiotherapy exercises to get you back to playing sport as soon as possible.
These timeframes should be used as a guide only and may vary for individual patients based on the nature or extent of the actual surgery performed and individual circumstances.