ACL Reconstruction & Repair

Introduction

The anterior cruciate ligament (ACL) is one of the most important stabilising ligaments in your knee. This strong, rope-like structure connects your thighbone (femur) to your shinbone (tibia) and plays a vital role in keeping the knee stable.

When the ACL tears, it rarely heals on its own and can lead to ongoing instability, where your knee feels like it’s giving way. Fortunately, ACL reconstruction surgery is a well-established, highly successful procedure that can restore stability and allow you to return to an active lifestyle.

🦵 What Does the ACL Do?

Your ACL prevents your shinbone sliding too far forward and stops excessive twisting of the knee. Without it, you might feel your knee buckle, especially during sports or even day-to-day activities.

If untreated, ACL tears can cause further damage to the surrounding meniscus cartilage and joint surface — increasing the risk of long-term wear and tear (osteoarthritis).

🏥 How Do ACL Injuries Happen?

ACL tears often happen during sport — for example:

Rapid changes in direction
Bad landings after a jump
Direct tackles
Most patients hear a “pop” at the time of injury, followed by rapid swelling and instability.

How Do We Diagnose an ACL Tear?

Your history and examination often give a clear idea.
An MRI scan can help confirm the tear and also check for other damage, like meniscal tears or bone bruising. Occasionally, a final diagnosis is only made at the time of keyhole surgery (arthroscopy).

✅ Non-Operative vs Operative Treatment

Some people can strengthen the muscles around the knee enough to manage without surgery. However, evidence (e.g. NEJM, 2010) clearly shows that ongoing instability often leads to further joint damage.

If you want to continue with an active lifestyle — especially one that includes sport or twisting movements — reconstruction is often recommended.

🔪 Surgery: What’s Involved?

ACL reconstruction is a keyhole (arthroscopic) procedure. Here’s what happens:

The damaged ACL is removed.
A new graft is prepared — often using one of your hamstring tendons.
Small “sockets” are created in the femur and tibia.
The new graft is passed into place and fixed with small titanium buttons, allowing it to gradually grow into the bone.

Mr Frame uses a modern, less invasive technique called the Arthrex All-Inside, which requires only one tendon harvest (instead of two) — this means less pain, less muscle weakness, and quicker recovery.

🧑‍⚕️ After the Operation

ACL surgery is usually performed as a day-case or with an overnight stay.
Physiotherapists will help you with crutches and simple exercises before you go home.
Keep dressings dry — the waterproof dressings can be left in place until your review.
Ice and elevation will reduce swelling — aim for 20 minutes every 2–3 hours.
Weight bearing as tolerated — most people put weight on the knee straightaway.

You will be seen for a wound check at 10–14 days and again by Mr Frame at 6 weeks. Physiotherapy is key to recovery, starting immediately and progressing to more sports-specific exercises at around 3–4 months.

⚠️ Risks & Complications

Every surgery carries some risk. Thankfully, serious problems are rare. Possible complications include:

Infection (~1 in 200), needing antibiotics or further surgery
Deep vein thrombosis (DVT) — blood clots in the legs
Stiffness — reduced movement can occur if exercises are not followed
Graft failure (~5% risk), which might require revision surgery
Numbness around the knee due to small skin nerve damage
Residual pain especially if there was other damage inside the knee
Medical risks like heart or breathing problems under anaesthetic

Your anaesthetist will review you before surgery to help minimise these risks.

🏃‍♂️ What’s the Success Rate?

ACL reconstruction is one of the most successful orthopaedic operations. Large published series (e.g. AJSM, 2018) report a ~95% success rate, with most patients returning to sport after about 6–9 months of structured rehabilitation.

🤔 Next Steps

If you’d like to discuss your knee pain or instability, or you want to find out whether ACL surgery is right for you, please get in touch with us at Wessex Knee. Mr Frame will assess you thoroughly and create a personalised plan to help you regain strength, confidence, and mobility.

💬 Have more questions?
Call our friendly team to arrange a consultation — we’re here to help you get back on your feet.