Anterior Cruciate Ligament Reconstruction

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Anterior cruciate ligament reconstruction is performed in two ways either using the hamstring tendons taken from behind the knee and thigh or using part of the patellar tendon which is the tendon below the kneecap. Most anterior cruciate ligament reconstructions performed in this hospital are performed using the hamstring tendons. The long term results of both methods are similar.

During surgery, the tendons are fastened into the knee using a system of screws and pins via a keyhole technique (arthroscopy). The new ligament is placed in the centre of the knee exactly where the original ligament was. Any repair or removal of torn cartilage is performed at the same time.

Will I be asleep?
Yes. The operation is done under a General Anaesthetic for most people, but it is possible under a Spinal Anaesthetic.

How long does it take?
The operation takes about 1 to 1½ hours.

What will it feel like afterwards?
As the operation is done by a keyhole technique the amount of pain people feel is very variable. We try to minimise pain felt. Any pain you may feel should be controlled with painkillers, and using ice to help swelling.

What can go wrong?
This type of surgery is generally very safe, but there are a few possible complications you should know about.

Anaesthetic: Rarely problems can occur related to your general health and the anaesthetic. The majority of potential problems should be picked up at the pre-assessment clinic. Your Anaesthetist will be able to discuss this further with you.
Swelling: Some swelling is common afterwards but usually improves slowly and should resolve by 8-10 weeks.

Anterior Cruciate Ligament Reconstruction
Bleeding: This can make the knee stiff and swollen. The blood can be removed through a needle in hospital if required.
Infection: Very rarely, infection develops inside the knee. This needs further surgery to drain and wash it out as well as antibiotics.
Giving-way/ RE-RUPTURE: After the operation the knee feels weak.

As the muscles regain strength this slowly improves. Very rarely the graft fails and re-ruptures, this is either due to another injury or because it stretches and becomes non-functional. Further operations may be needed if this happens.

Deep vein thrombosis: This can occur to any one under going lower limb surgery. The risk is greater if you have had one before or are on the oral contraception pill/hormone replacement therapy (which should be stopped 6 weeks before operation). They rarely cause direct problems, but can potentially be serious because of the risk of spread to the lungs (pulmonary embolism). Treatment usually involves taking Warfarin (to make the blood clot less easily) for a 3 month period.

Numbness: Some numbness may develop because small sensory nerves may be divided during the operation. The area involved is small over the outside of the calf and usually resolves.

How long will I be in hospital?
Most people are in hospital for one night after the operation and go home the next day. During this time you will have intensive physiotherapy and be taught correct methods to walk.

What will I be able to do when I go home?
When you go home you can walk on the leg, you should use crutches for at least 2 weeks to allow the thigh muscles to regain strength. The Physiotherapist will give you a thorough briefing on what to do.

What Outpatients Physiotherapy will I need?
After this type of surgery, rehabilitation is very important. You will start your physiotherapy immediately after the operation. Rehabilitation is done following a set routine and this will be explained to you by the physiotherapist before you go home.

You will be seen after your operation by your surgeon. After discharge you will be seen again at 2 weeks, 6 weeks, at about 3 months and 6 months. In the long term you will not need to come to hospital for follow-up unless there are any problems. However, we are keen to find out how our patients are progressing. You may therefore be contacted to complete a postal questionnaire some time after your operation. Any information returned would be handled sensitively and confidentially, in accordance with the Data Protection Act 1998.

When can I drive?
Most people are fit to drive 5-6 weeks after surgery. Ideally you should wait until 6 weeks after surgery if possible. You can discuss this further with your surgeon. You are also advised to contact your car insurance company before you start to drive again.

When can I go back to work?
This depends on your job. If it is an office job, you can go back after about 2 weeks. If you have a manual job, especially if it involves kneeling or climbing you will need longer, possibly up to 8-10 weeks.

When can I play sport again?
It is very important that you do not risk damaging the new ligament too soon after the operation. it is easy to snap or loosen the repair in the first 3 or 4 months if you are not careful. Your Surgeon or Physiotherapist will give you appropriate individual advice, but we advise against non-contact sport for 6 – 8 months and contact sport such as football for at least 10 – 12 months.

How soon after my operation can I fly or go on holiday?
You should be able to go away within the United Kingdom after 48 hours, providing any long journeys are appropriately broken. However, you should ensure you do not miss any of your physiotherapy appointments. Flying immediately after lower limb surgery is associated with an increased risk of deep vein thrombosis (see section ‘What can go wrong?’). Although no fixed
guidelines exist, we recommend that you should not fly for 6 weeks following an ACL reconstruction.

Can a reconstruction be done again if I injure my knee?
Yes, but it is much more difficult and you are less likely to get a stable knee.

Will I get arthritis later?
We know that patients with an unstable knee are more likely to get arthritis. Even though the operation may seem successful in giving you a stable knee that works well, there is still a slightly increased risk of arthritis later in life.

What do I do if I have a problem after my operation?
During the daytime you can contact the ward where you stayed for your operation for initial advice. Out of hours you should contact your usual GP services or attend the Accident and Emergency Department.

What happens next?
Your name will be placed onto the waiting list. You will be invited to attend for:
• Pre-assessment – to make sure you are well enough for the operation, you will receive an appointment letter approximately 2 -6weeks before your operation date for this
• Physiotherapy –you may be invited to attend for physiotherapy for muscle strengthening exercises before your operation

People are unique and the alternatives, risks and benefits will of course vary from person to person. We hope this leaflet will support the information you have already received from your doctor in enabling you to make an informed decision.

If whilst on the waiting list you feel you no longer need this operation speak to your family doctor in the first instance and secondly let the Admissions Office at the hospital know on 01908 243912 or 243872.