Before surgery
Your operation will be performed by a specialist knee surgeon, usually as a day case procedure at Chapel Allerton Hospital.
Anterior Cruciate Ligament injury
In this video our surgeon Mr Sanjeev Anand explains what the anterior cruciate ligament is, what happens if it is injured and how it can be treated or repaired.
Anterior Cruciate Ligament Surgery – Meet our Surgeon, Mr Sanjeev Anand
My name is Sanjeev, and I am a knee surgeon at Ä¢¹½tvÊÓƵ Teaching Hospital, specializing in knee injuries in children and young adults. Today, we’re discussing the anterior cruciate ligament (ACL), which is one of the main ligaments inside the knee. The ACL plays a crucial role in stabilizing the knee, especially during twisting movements.
ACL injuries are unfortunately common, typically occurring during sports that involve pivoting or twisting. While contact injuries with others can lead to ACL tears, they often happen without contact when the knee twists awkwardly.
When an ACL injury occurs, it often involves significant force to the joint, causing a popping sensation in the knee, followed by swelling. People may experience limping for a few days to two weeks after the injury.
It’s essential to recognize and diagnose this injury promptly to ensure appropriate and timely treatment. If you have injured your knee and notice significant swelling or difficulty moving it, you should seek medical attention. Either a GP or an urgent care service can guide you through the appropriate next steps. Most hospitals have acute knee services where these injuries can be assessed and properly managed.
During your assessment, the clinician will check for not only ACL damage but also injuries to other structures around the knee, such as different ligaments, which may influence the management of your ACL injury.
A thorough clinical assessment will help identify the extent of the injury. Your doctor or clinician may recommend further imaging, such as X-rays or an MRI, to check for additional damage, as this will influence the treatment approach.
Your clinician will then discuss the treatment options available to you. Treatment could involve surgery or a trial of physiotherapy, depending on factors such as your activity level and the extent of damage to other structures in the knee. Some people may manage without surgery, particularly if their sport mostly involves running in a straight line. In such cases, physiotherapy might be an option to help manage the injury.
However, if there are other injuries to the knee, surgery might be the best course of action. Surgery is typically recommended once you’ve regained full range of motion in the knee, a process known as prehabilitation. Physiotherapy may be recommended to help restore knee movement and strength, as this can improve the outcome after surgery.
In certain cases, surgery may be necessary urgently, and your surgeon will advise you on the best course of action. When surgery is required, it typically involves reconstructing the ACL using a graft. There are various graft options, such as hamstring tendon or patellar tendon, and your surgeon will discuss the benefits of each with you.
In this video Nyla a lower limb physiotherapist will explain what happens when you have an injury to your ACL.
What happens when you have an injury to your ACL
Hi, I’m Nyla, and I’m one of the lower limb physiotherapists. Today, I’m going to talk to you about what you can expect after a suspected ACL injury.
Once you’ve injured your knee and assessments have been made, you may need to wait for imaging results. After that, you will be referred to physiotherapy to help improve the movement in your knee.
Managing swelling is crucial, and you may be advised to elevate your knee, apply ice (if allowed), and begin gentle early exercises. As your knee improves and your range of motion increases, you can start early strengthening exercises, which will continue to enhance your function and overall outcome.
In some cases, there may be restrictions on certain activities, particularly if there are additional injuries, such as a meniscus tear. For example, you may be advised to avoid deep squats or bending while carrying weight.
The period between the injury and surgery, known as the rehabilitation phase, is critical for achieving the best possible outcomes if surgery is needed. However, as my colleagues have mentioned, there is also a successful conservative treatment path that doesn’t require surgery, which can lead to excellent results as long as the right exercises are followed and the injury is managed well.
Whether you pursue conservative or surgical treatment, it’s important to focus on equalizing strength between your legs and working to improve the strength of the injured leg compared to the uninjured one. The physiotherapy team and strength and conditioning team will work with you to help achieve this goal.
To help prepare you knee for your operation you need to start doing some exercises that will help strengthen the muscles around your knee to help you recover as quickly as possible.Â
See the videos in our exercise section, perhaps try and do these with friends and family before you come into hospital.
Your Surgery
On the day of your operation you will have the opportunity to ask questions. You will meet a physiotherapist and your anaesthetist who will explain what happens when you have an anaesthetic and answer any questions you might have.
You will also meet your surgeon who will discuss the indications, benefits and risks of you surgery. The knee undergoing surgery will be marked and you will be asked to sign a consent form.
The operation can take up to 1½ hours.
You will be asked to change into a theatre gown and you may be asked to wear compression stockings, these help reduce the risk of developing a blood clot. With leg surgery these are frequently not worn on the operated leg, but the nurses preparing you for your operation will tell you if and how you need to wear them.
In this video Kimberly, one of the physiotherapists will explain what happens before your knee surgery.
What happens before your knee surgery
Hi, my name’s Kimberly, and I’m one of the physiotherapists on the orthopedic unit at Chapel Allerton Hospital. We will see you on the morning of your surgery to fit you for crutches and teach you how to use them, depending on your weight-bearing status and the type of knee repair you have.
We will also guide you through the basic exercises you’ll need to do during the first few weeks after surgery and provide education on managing swelling with ice. It’s normal to experience swelling after surgery. Once your nerve block wears off and you can feel your knee, we recommend using ice up to five times a day to help reduce swelling. You can use a bag of frozen peas wrapped in a damp cloth for this. Apply the ice for a maximum of 20 minutes at a time and always check for any adverse reactions on your skin.
It’s important to follow our advice on crutch use and not to stop using them until you’re instructed to do so at your outpatient appointment. The exercises we provide are essential for keeping your knee moving, especially to help straighten it after surgery, and to activate your quadriceps muscles for stability around the joint.
Post-surgical pain is normal, and it’s important to take your pain medication as prescribed. We recommend timing your exercises approximately 30 minutes after taking your pain relief to help manage any discomfort.
After Surgery
When your operation is finished you will usually be taken to the recovery area until you wake up from the anaesthetic. The wound on your leg will be covered by a simple dressing and a bandage will be wrapped around the knee. An x-ray may be performed for your surgeon to review your knee. When you are well enough, you will be transferred to the ward.
Below is a video about what happens after your operation, and what it’s like to wake up in the recovery room.
After your ACL operation
Hi, my name is Kimberly, and I’m one of the physiotherapists on the orthopedic unit at Chapel Allerton Hospital. After your surgery, you’ll be taken to the recovery room where the nurses will monitor your heart rate and blood pressure as you wake up from the anesthetic.
Once you’re awake, feeling well, and have had something to eat and drink, we will visit you again from physiotherapy. At this point, we will review your operation notes and inform you of your weight-bearing status and whether you need a brace. If you require a brace, we will apply it for you.
We will assess your leg to check if your sensation has returned and if your muscles are activating. If you haven’t regained sensation but are eager to go home the same day, you will need to remain non-weight-bearing, which we will have practiced with you before surgery. We will also review the information and exercises we provided earlier and help you get out of bed and walk.
Depending on how you are feeling, the effects of the anesthetic, and whether your pain is well controlled, you may be able to go home that day.
Before discharge you will spend time with a physiotherapist and when your pain is under control you can go home. It is normal to have some pain, swelling and bruising to your thigh, knee and leg after your operation.
Good pain relief is important to ensure adequate range of movement and prevent stiffness, it is important that you feel comfortable enough to breath deeply, cough and move around. Before you come to hospital we recommend you have some simple pain relief medication at home such as paracetamol so that you don’t need to worry about getting to the shops for the first few days after your operation.
After your operation you will be able to move your knee and weight bear as your pain allows but crutches are generally required for up to three weeks.Â
We have videos about how to use your crutches and more information about wearing a knee brace.
Rehabilitation
Recovery from ACL reconstruction requires a lot of dedication towards your rehabilitation. You should commit to doing your exercises daily and attend physiotherapy on a regular basis for assessment and exercise progression. Rehabilitation after your operation is helped by preparing your knee and surrounding muscles before your operation by doing exercises before your operation.Â
See the exercises you can do before your operation on our exercise page.
Driving after your operation
As a general guide, depending on your range of motion and ability to perform an emergency stop, you should refrain from driving for around four weeks. You need to inform your car insurer about your surgery.
Returning to work
Return to office work should be possible after approximately 2-3 weeks. If you have a job that involves heavy physical work you should leave 8-12 weeks before going back to work.