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Ruptured ACL - Do I need to have surgery? Mr Alex Anderson answers your FAQs

Mr Alex Anderson, Consultant Orthopaedic Surgeon and member of Sheffield Orthopaedics Ltd (SOL)
Claremont Clinics: Wednesday AM, PM & Evening. Friday AM
 
‘Need’ is a strong word, the first thing to say is don’t panic, this is not a limb threatening injury so nothing surgical ever has to be done however there are a lot of things for you to consider. Whether to have surgery to your knee following an ACL (Anterior Cruciate Ligament) rupture will depend on many factors all of which will be discussed at length with you during your consultation. It is very much tailor made to the individual and their requirements and expectations alongside the possibility of additional structural injury to cartilages (menisci) and/or other ligaments.
 
There is no doubt that many individuals (around 30%) with an isolated ACL rupture may return to all their usual activities including some sports with conservative’ treatment alone. This usually consists of an expert physiotherapy programme and occasionally an ACL knee brace for certain specific activities such as skiing. However returning to regular pivoting sports (running and changing direction at speed -  football, rugby, netball etc.) is much less likely especially on a competitive basis without surgery and attempts to do so on an unstable knee put other structures within the knee, such as the menisci, at risk of injury too. This could predispose you to developing osteoarthritis at an earlier stage in life. You may however decide you wish to hang up those football boots or equivalent and change your lifestyle and exercise regime to non-pivoting activities to accommodate the fact your knee is unstable. However if it is affecting you in your daily life at work then that is clearly more difficult to adjust!
 
How do you do the ACL reconstruction?
Because the ligament doesn’t heal and cannot be repaired (partly because it has a poor blood supply) then it has to be reconstructed. I usually use a hamstring tendon graft, taken from the same injured side through a small incision over the front of the shin. Using a hamstring graft almost never causes any problems with function in the long term. If other structures in the knee are damaged then they are usually addressed at the same time. This means that with the exception of the small incision for the hamstrings the rest is a keyhole/arthroscopic operation.
Currently over 80% of my ACL reconstructions are done as day cases. If you are worried about being ‘put to sleep’ frequently the surgery is undertaken under spinal anaesthesia with you awake but numb from the waist down and my anaesthetist will discuss both options with you. View our information page on ACL reconstructions here
 
How long will I take to recover?
You are not laid up for any length of time! In fact quite the opposite we encourage you to get going and moving on your knee as soon as possible. Most patients are discharged with a tubigrip bandage over their dressings and a pair of crutches for support only. You are allowed to fully weight bear straight away.
The first few days are uncomfortable but not painful. Most patients have discarded their crutches between 2-4 weeks and are mobilising with a barely discernible limp at 6 weeks. You can return to driving at 4 weeks. You shouldn’t fly overseas, especially long haul, for 6 weeks. It is common for the swelling to take several weeks to dissipate and you may notice some bruising and discomfort in the back of your thigh from the hamstrings.
 
Are there any complications?
Complications are very rare and the vast majority of patients have a very smooth recovery. The chances of a successful result at returning your knee to near normality is as previously mentioned around 85-90%. Your surgeon will go through any possible complications with you. Further information can be found here

Re-rupture of the graft occurs in 5-7% of individuals according to most databases although my personal experience is much less than that. It usually occurs as a result of repeat injury before the graft has fully taken and is why it is so important to head the instructions and advice from my physiotherapy colleagues. Once you are two years after surgery research would suggest you are more likely to rupture the ACL in your normal knee than your reconstructed one!

When can I return to playing sports?
Our physiotherapy department have developed a comprehensive rehabilitation programme which you will be enrolled on and provided with. Playing pivoting sport non-competitively or training is permitted at 6 months but a return to competitive sport should be delayed until 9-12 months following surgery. Non-pivoting sports s may be possible from 3 months onwards. Our physiotherapists will help guide you as to when is appropriate. It is important that you also have completed the Prevent Injury and Enhance Performance (PEP) programme.
 
A private consultation with Mr Anderson at Claremont costs £200 if you don't have health insurance with private ACL surgery starting at £5,182. For more information or to book an appointment, just call our Private Patient Team on 0114 263 2114. You will need a referral letter from your GP or you can see one of our Private GPs quickly for this if you prefer.
 
Copyright Alex Anderson, 2017
Date: 14/08/2017
By: Paula Lee
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