Tissue is sourced from the patient’s own body, typically the patellar tendon or hamstring tendons. This method ensures high biological compatibility, reducing the risk of immune rejection. However, harvesting the graft can cause discomfort at the donor site and may lengthen recovery for that area.
ACL Surgery
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Anterior Cruciate Ligament (ACL) reconstruction surgery repairs or replaces a torn ACL, one of the primary stabilising ligaments in the knee joint.
The procedure involves removing the damaged ligament and replacing it with a tissue graft. Grafts are typically sourced from another part of the patient’s body (autograft) or from a donor (allograft). The surgery restores knee stability and function, enabling patients to resume daily activities and sports.
Indications for ACL Surgery
ACL reconstruction surgery may be recommended under the following conditions when knee stability or function cannot be achieved through conservative measures:
Complete ACL Tear: A complete rupture of the ligament results in significant instability, making basic movements like walking or climbing stairs challenging. This often disrupts daily activities and requires surgical intervention to restore functionality.
Failed Conservative Treatment: When physiotherapy, bracing, or other non-surgical methods fail to alleviate symptoms or restore stability, surgery becomes necessary to address the underlying structural damage.
Athletic Participation: Individuals engaged in sports involving jumping, pivoting, or sudden directional changes may require surgery to regain the knee strength and stability needed for these activities.
Combined Knee Injuries: ACL tears often occur alongside injuries to the meniscus or cartilage, which may worsen without surgical repair. Treating all injuries simultaneously improves overall joint health and functionality.
Benefits of ACL Surgery
ACL reconstruction surgery provides both immediate and long-term benefits, helping patients regain mobility and protect their knee joint.
- Knee Stability
The procedure restores the mechanical integrity of the knee, allowing for more consistent and controlled movements during daily activities and physical tasks. - Return to Sports
Surgical repair enables a safe return to sports and other high-demand activities by providing the necessary structural support for dynamic movements. - Prevention of Future Injury
Stabilising the knee reduces excessive stress on surrounding structures, such as the meniscus or cartilage, thereby minimising the risk of secondary injuries. - Joint Longevity
By preventing abnormal joint mechanics, the surgery lowers the likelihood of long-term complications like arthritis, preserving joint health over time.
Surgical Techniques
ACL reconstruction can be performed using various techniques, each chosen based on individual patient needs and surgeon expertise. Below are the commonly used methods:
Autograft
Allograft
Donor tissue from a cadaver is used, eliminating the need for a graft from the patient. This approach reduces surgical time and avoids donor-site complications, making it less invasive overall. Despite these benefits, graft integration may take longer, and there is a minimal risk of disease transmission.
All-Inside Technique
This minimally invasive method uses smaller incisions and specialised fixation devices to secure the graft. It causes less disruption to surrounding tissues, potentially speeding up early recovery. However, this technique requires specialised equipment and may not be suitable for all patients based on anatomical or clinical factors.
Preparing for ACL Surgery
- Medical Evaluation
The patient undergoes imaging studies and a thorough health assessment to ensure surgery readiness. Any chronic conditions, such as diabetes or high blood pressure, are managed to minimise risks. - Medication Adjustments
Blood-thinning medications are discontinued 7–10 days prior to reduce bleeding risks, and anti-inflammatory drugs are stopped 5–7 days before surgery. Patients receive specific instructions regarding routine medications, including any temporary changes required. - Pre-operative Guidelines
Patients are instructed to fast for 6–8 hours before the procedure to ensure safety during anaesthesia. Completing prescribed pre-operative physiotherapy exercises strengthens the knee, supporting recovery.
Step-by-Step Procedure
Anaesthesia
The patient is administered either general or spinal anaesthesia based on clinical considerations and personal preferences. Throughout the procedure, vital signs are closely monitored to ensure safety, and the surgical area is sterilised to maintain a sterile environment.
Graft Harvesting
For autografts, the surgeon removes the tendon from the chosen donor site, such as the patellar or hamstring tendons, and prepares it for implantation. If an allograft is used, the pre-processed donor tissue is prepared without additional harvesting. The graft is customised to fit the patient’s anatomy.
Arthroscopic Assessment
A small camera, called an arthroscope, is inserted into the knee joint through a small incision, allowing the surgeon to examine the joint. Any additional injuries, such as meniscal tears, are addressed, and damaged ACL tissue is removed to prepare the site for graft placement.
Tunnel Creation
Tunnels are drilled in the femur and tibia at precise angles to replicate the natural attachment points of the ACL. These tunnels are carefully sized to accommodate the graft and ensure proper alignment for optimal stability.
Graft Placement
The prepared graft is threaded through the drilled tunnels and securely fixed in place using screws or specialised buttons. The surgeon adjusts and tests the graft’s tension and alignment to confirm stability before closing the incisions.
Wound Closure
The surgical area is cleaned, and the incisions are closed with sutures or surgical staples. A sterile dressing is applied, and the knee is immobilised as necessary. The patient is then monitored during recovery from anaesthesia before being discharged with post-operative instructions.
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Post-Surgical Care and Recovery
- Immediate Care
Pain is managed with medication and ice therapy to reduce swelling. The knee is kept bandaged and elevated, and patients are encouraged to rest during the initial recovery phase. Light exercises to maintain mobility begin under physiotherapy guidance. - Recovery Process
Weight-bearing starts gradually, often with crutches for 1–2 weeks based on the surgeon’s recommendation. Range-of-motion exercises progress over 6–12 weeks, followed by strengthening exercises as the knee stabilises. The timeline for returning to normal activities varies depending on individual progress. - Follow-Up Care
Regular check-ups monitor healing and address any potential issues. Physiotherapy continues for 6–12 months, focusing on rebuilding strength and flexibility. Clearance for sports is given only after passing functional tests, typically 9–12 months post-surgery.
Potential Risks and Complications
ACL reconstruction surgery carries general risks, such as infection, blood clots, or reactions to anaesthesia. Possible complications include graft failure, stiffness, or persistent pain in the knee. Some patients experience numbness near the incision site or ongoing instability, which may require further treatment. Proper surgical technique and adherence to a rehabilitation program reduce these risks.
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
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Frequently Asked Questions (FAQs)
Can ACL tears heal without surgery?
Partial tears or tears in patients with low physical demands may be managed without surgery using physiotherapy, bracing, and activity modification. Complete tears or those causing significant instability, especially in active individuals, are unlikely to heal properly without surgical intervention.
Will I need a knee brace after surgery?
A knee brace is often recommended during the first 4–6 weeks to support the joint during early healing. Whether it is needed long-term depends on your activity level and the surgeon’s advice. It may provide additional protection for certain high-risk activities.
Are there any long-term limitations after ACL surgery?
Most patients regain full function and return to their desired activities after rehabilitation. However, some may experience mild residual stiffness or discomfort. High-impact sports may carry a higher risk of re-injury, so proper technique and conditioning are advised.