ACL reconstruction surgery: Everything you need to know

A ‘popping’ sound followed by immense pain is a good indicator that you’ve torn your anterior cruciate ligament (ACL). But what happens next?

While not everyone who tears their ACL requires reconstruction, others do. Read on to learn everything you need to know about ACL reconstruction surgery.

Your ACL is a band of fibrous tissue that helps to stabilise your knees. An ACL injury usually happens when you slow down very quickly while turning or sidestepping at the same time.

In Australia, which has one of the highest rates of ACL injuries in the world, 72% of them are sports related.¹ Basketball, netball, rugby, AFL, soccer, gymnastics and skiing are usually to blame.

If you’ve only partially torn your ligament and your knee is stable, or if you’re older and don’t do physical activities that place a lot of strain on your knees, you may not need reconstructive surgery. Physiotherapy and a supportive hinged knee brace might be enough.

If you’ve torn your ACL and you’re experiencing instability (meaning your knee gives way), your doctor may suggest a reconstruction to help improve stability and knee function if you:

• previously played a lot of sport and want to get back to it
• have an active job that involves heavy lifting or is unsafe to have an unstable knee
• have other damage to your knee, such as a meniscal tear
• have knee injuries that put you at risk of osteoarthritis.

ACL injuries don’t always need an immediate fix. You may still have an operation many months later if your knee doesn’t recover well enough with physiotherapy.

There are a few instances where immediate surgery may be required, including if:

• you have other knee injuries that need surgical repair
• you need to quickly get back to sporting activity or work.

Deciding to have surgery can be a hard decision to make. So, it’s a good idea to think about the pros and cons before going ahead. Some of these include:

• ACL surgery could help stabilise your knee, relieve pain and reduce the risk of further knee injury.
• You may be allowed to start playing sports following surgery.
• Using a keyhole procedure, ACL surgery is less invasive than some other forms of surgery. This can result in less hospital time, less pain and faster recovery.

• It can take 6 to 12 months to fully recover from ACL surgery.
• You must stick to an exercise program for several months after surgery to help you recover.
• As with all surgery, you might experience side effects and risk complications.
• ACL reconstruction doesn’t work for everyone. You may still not be able to play sport, and you could continue to experience pain or stiffness in your knee.

If your knee has swollen up like a balloon, your surgeon may delay the operation for a few weeks.

It’s best to undergo the surgery when you’re pain-free and have full range of movement in your knee. Otherwise, the result may not be optimal.

While you’re waiting for your surgery, your doctor may ask you to undergo physiotherapy, which can help:

• reduce swelling
• strengthen surrounding muscles
• improve post-surgery recovery time.

Using keyhole surgery, an ACL reconstruction is done by taking a piece of tendon from somewhere else in your body, like your hamstring or patellar tendon, and creating a new ligament out of it.

In some cases, surgeons may need to use a graft from a donor. This will most likely occur if you’re having further surgery to an ACL repair because of injuries to other ligaments and tendons in your knee, or if you’ve had an unsuccessful ACL reconstruction in the past.

Most ACL surgeries take about one to 3 hours. An overnight hospital stay might be required.

As with any procedure, ACL surgery can have side effects, including:

• pain
• swelling (which may continue for 6 weeks after the operation)
• bruising
• stiffness.

A physiotherapist will give you recovery exercises and crutches following your operation.

When you’re not moving around or doing exercises, you should keep your leg elevated as much as possible. It’s important to take it easy and avoid too much standing, walking or any bumps to the knee. Expect to have dressings over the small wounds around your knee.

Recovering from an ACL reconstruction usually takes between 6 to 12 months, however it can vary between individuals. It’s important to not rush the process and always follow your surgeon and physiotherapist’s advice.

As with most surgery, recovery pain can be expected. Your doctor may recommend over-the-counter medications, such as paracetamol or ibuprofen. You can also manage pain and swelling using a cold compress.

From 2 weeks after the surgery, you should be able to fully straighten your leg, bend it to 90 degrees and walk normally without crutches.

Some surgeons or physiotherapists may provide you with a knee brace to help support your joint as it heals. Some people also wear a knee brace when they return to playing sport.

You won’t be able to drive until your surgeon gives you the go-ahead.

You also shouldn’t hop on a long-haul flight for at least 6 weeks after surgery. Your surgeon may recommend waiting longer, and it’s important to make sure you follow their advice.

If you have a desk job, you may be able to go back to work 2 to 3 weeks after your operation, or possibly sooner. If you have an active job, however, it may take between 2 to 3 months before you can start working again.

Most people can’t play sport until 6 to 12 months after their operation. However, this timeframe can depend on how well you’re recovering.

Possible complications of any operation include excessive bleeding, having an unexpected reaction to the anaesthetic or developing a blood clot.

Although rare, further potential complications of ACL reconstruction surgery include:

• infection
• viral transmission
• numbness
• chronic instability
• stiffness in your knee or kneecap pain
• rupture or fracture of your patellar tendon
• growth plate injury (which affects younger people and may lead to bone growth problems).²

For more information about ACL injuries, reconstruction and recovery, speak to your doctor.

The Australian Physiotherapy Association can help you find a physio near you.

Chronic Pain Australia provides education and support for those living with chronic pain.

Musculoskeletal Health Australia provides information and support for people living with arthritis and musculoskeletal conditions. Visit their website or call them on 1800 263 265.