Anterior Cruciate Ligament Surgery

Before surgery

If you have medical conditions then you may be invited to attend a pre-assessment clinic by one of our specialist nurses. Routine blood tests, tracing of the chest (ECG) and an MRSA swab will be performed to ensure you are safe to be admitted to hospital.

If you have any source of infection then you need to contact us at your earliest convenience. For example any cuts or grazes near the knee or a dental / chest infection. Your surgery may well need to be postponed for your safety.

Some medication for the heart / tablets to thin the blood / tablets to control rheumatoid arthritis will need to be stopped and can be discussed with our pre-assessment team.

Please do NOT shave your knee or apply moisturisers.

Seeing a physiotherapist prior to surgery will improve your recovery after surgery. This is termed pre-habilitation. The physiotherapist also will help reduce swelling and inflammation.

Follow instructions to stop eating and drinking before surgery. Usually 6 hours before you should not eat ( 2 hours for plain water).

We perform pre-operative checks according to the World Health Organisation to ensure that we operate on the correct site.

During Surgery

You will have a general anaesthetic administered to you.

Small cuts will be placed at the front of your knee to allow a camera to be placed inside and specialist equipment to prepare your knee for the graft. Another small cut is needed below your knee to allow the graft to be taken from your hamstrings.

The hamstrings are folded over one another and stitched together to provide a new, strong ligament. Holes are drilled in your femur and tibia and the graft is secured within these tunnels.

Other grafts choices are available and if relevant will be discussed.

Once finished the fluid is removed, copious local anaesthetic inserted and the skin closed with dissolving stitches and adhesive dressings.

After surgery

You will need to recover from the anaesthetic given and that should not take more than a few hours.

The knee may feel some discomfort but should be easily managed with painkillers such as paracetamol or ibuprofen.

You will be seen by physiotherapy staff who will ensure you understand any special instructions from surgery and issue you with a brace or crutches if needed. You will also get an information sheet with activities to perform to ensure a quicker recovery to function.

If you are deemed to be at high risk of DVT then you will go home with tablets that thin the blood for 2 weeks. These sadly can increase the risk of bleeding, bruising and swelling in and around the knee.

Risks of ACL surgery

ACL surgery is a successful operation for patients to regain stability in their knee. Not all people need ACL reconstruction when their ACL is damaged. It is, however, a successful low-risk procedure for restoring stability to a knee. Most of the time the graft we choose is adequate but rarely may need to be reinforced by taking a graft from elsewhere.

Failure – the graft may fail to incorporate or stretch out leading to instability. Approx 6%. The failure rate increases significantly if you smoke and fail to complete the full physiotherapy course.

More serious problems are much less common, occurring in less than 1 in 100 cases. They include:

A blood clot that develops in one of your legs – this is known as deep vein thrombosis (DVT) and it can cause pain and swelling in the affected limb. This can sometimes go to the lungs and cause a pulmonary embolus (PE) which in rare circumstances can cause death.

Infection inside the joint – known as ‘septic’ arthritis and it can cause a high temperature (fever), pain and swelling in the joint. Infection will always require further surgery.

Infection outside the joint – May require a short course of antibiotics to treat this ‘portal’ infection.

Haematoma – Bleeding inside the knee.

Damage to the nerves that are near the joint – this can lead to numbness, sensitivity and some loss of sensation, which may be temporary or permanent. It is quite common to have numbness where the graft was taken (a branch of your saphenous nerve).  Less common for numbness to happen in the territory of the saphenous nerve itself.

Chronic regional pain syndrome – is a greater than normal reaction by the body to an injury or surgery. This can lead to chronic pain, swelling and skin changes.

Arthrofibrosis – Stiffness and scarring inside your knee after an ACL reconstruction is rare and classically happened when surgery was performed in an angry inflamed knee.

Compartment syndrome – This is when the leg swells significantly and may need further surgery to release the swelling and pressure in the muscular compartments in the calf.