Reconstruction of the ACL is usually done via arthroscopy, otherwise known as keyhole surgery. Your surgeon will make minor incisions in your knee and insert a small surgical camera (an arthroscope) to examine the inside of the joint. Other incisions will be made to allow access for surgical instruments. The procedure typically lasts between one and three hours, depending on whether further damage is discovered. It's usually performed under general anaesthetic.

How to prepare for ACL surgery

Before having the surgery, you may need to wait for any swelling to go down and to regain movement in your knee. This will make recovering from surgery easier. 

If your knee is still sore and stiff, preoperative physiotherapy will be required to prepare your knee for your operation. As part of our ongoing commitment to the gold standard requirement for pre-operative physiotherapy, your consultant may also advise you to wait until the muscles at the front and back of your thigh are as strong as possible.

Your consultant will explain the procedure to you fully, going over any potential risks and side effects. Your options for anaesthetic will also be discussed. Most people will have an ACL reconstruction under general anaesthetic (fully asleep). However, it can also be performed under regional anaesthetic, known as an epidural, where the lower part of your body is made numb.

If you are having general anaesthetic, you will be told to avoid eating or drinking for a period before your surgery. You’ll be asked for details of any medicines you regularly take to help inform your treatment plan. If you’re a smoker, you will be asked to refrain from smoking before and after the surgery to aid recovery.

What happens before an ACL reconstruction?

You will need to bring in any medication you take regularly and arrange your transport home for later that day. Many people come to hospital with a friend or family member who can also take them home afterwards.

When you arrive at one of our hospitals for ACL surgery, you will be shown to a private room by our nursing staff. They will also perform pre-operative checks such as taking your temperature and blood pressure.

Your surgeon and anaesthetist will visit you ahead of the operation to explain things once again and give you an opportunity to ask any questions. When it is time for your operation, you will change into a surgical gown and be taken to theatre where an anaesthetist will begin administering your anaesthetic.

What happens during ACL reconstruction surgery?

Small incisions, known as portals, will be made in your skin to allow the surgical camera and tools to access your knee joint. A clear and sterile fluid will be pumped into the joint to expand it and make it easier for the surgeon to see on their monitor and manoeuvre around your knee.

Once set up, your surgeon will examine the entirety of your knee to confirm your initial diagnosis and check for any further damage that may need repairing. They may also take photographs of your knee joint to help inform your aftercare needs or future procedures.

Tissues from the patellar tendon or hamstring tendons are often used to repair the damaged ACL in reconstruction surgery. These are typically harvested and prepared at the time of surgery. In some cases, donated tissue called allograft is used instead. Synthetic grafts may also be used when multiple ligaments are affected or in cases of revision surgery. Small tunnels are very precisely drilled into your leg bones where the new ACL needs to pass. The chosen graft will be secured into the site where your old ACL was with screws, buttons or staples. These will remain in place permanently.

After the reconstruction has been completed, your surgeon will test the strength of the graft and examine how it performs through your knee's full range of motion. They will then remove the tools and fluid from your knee and close the portals using stitches or steri-strips.

What happens after ACL reconstruction surgery?

You’ll be taken to a recovery area and then your private room as the effects of your anaesthetic wear off. Our nursing staff will be there to offer anything you need including pain relief. Once you’ve fully come around, you will be offered something to eat and drink.

It's unlikely that you'll stay in hospital overnight following an ACL reconstruction, but you'll need someone to drive you home and may require additional help in the early stages of your recovery. You will be provided with crutches to help you get around immediately after your operation. People typically use them for a few weeks after undergoing ACL reconstruction to avoid putting weight through the affected knee.

Our staff will explain any medication that you need to bring home with you, as well as advise on some physiotherapy exercises you can do at home to help the recovery process. We might also schedule some appointments with you to check-up on your recovery.

Once we have performed all necessary observations and you’re comfortable getting around, you will be free to go.