Anterior Cruciate Ligament Reconstruction

The function of the anterior cruciate ligament is to control the amount of twisting which can take place between the top part of the knee (femur) and the bottom part of the knee (tibia). The anterior cruciate ligament (ACL) is found in the centre of the knee joint and is often injured by a sudden strong twisting motion, eg losing control of your skis or falling off a ladder.

If the ACL is ruptured and the knee twists the two parts of the knee joint clunk against each other, resulting in damage to the meniscus and/or articular cartilage. The damage may be very severe or mild but with time the damage accumulates and may lead to early arthritis.

The aim of ACL reconstruction is to improve your quality of life and to slow down the destruction of the knee joint.

Prior to Surgery

Please refer to the Pre Operative Information sheet.

Common Questions

Q. How long do I have to fast before the operation?
A. Nothing to eat or drink for six hours before the operation.

Q. What type of anaesthetic is used?
A. General anaesthetic.

Q. How long will I need to stay in hospital after the operation?
A. Usually only for one day.

Q. Will I have pain?
A. You will have pain, the degree varying for different patients. Do not be afraid of taking pain killers.

Q. How soon can I drive?
A. You can drive as soon as you feel your knee is capable after two weeks.

Q. Are there risks in the operation?
A. These are very rare but include infection, blood clots (DVTs),stiffness, re-rupture and a numb patch on the lateral aspect of the knee.

Q. If I am taking medication what should I do?
A. It is very important that you inform all the people involved in your care, especially the Anaesthetist.

Surgical Procedure

An arthroscope is introduced into the joint and the joint is inspected. All visible damage is corrected. The area which used to be occupied by the anterior cruciate ligament is cleared and the bone surfaces are prepared to take the new ligament. The graft is usually a double stranded hamstring, ie using semitendinosus and gracilis tendons. In some circumstances a mid third patella tendon graft is used and the bony plugs in the femur and the tibia are fixed with screws.

When a hamstring graft is taken, a tunnel is drilled in the tibia and in the femur and the graft placed as close to its original position as possible. It is fixed in the femur by an Endobutton and in the tibia, usually by a screw, and secured with a staple.

A patient’s progress after surgery is significantly altered by other problems that may be encountered in the knee at the time of surgery. If there are any cartilage defects, then persistent pain and swelling is to be expected after surgery.