ACL Reconstruction Surgery in Singapore

An anterior cruciate ligament (ACL) injury involves damage to one of the key stabilising ligaments of the knee. The ACL plays a central role in controlling knee movement, particularly during pivoting and directional changes. Read more below:

ACL stands for Anterior Cruciate Ligament. It is one of the main knee ligaments (rope like structure) in the knee.

The ACL runs diagonally in the middle of the knee and attaches the thigh bone (femur) to the shin bone (tibia). It stops the shin bone from sliding forward and rotating excessively. The ACL crosses with the Posterior cruciate ligament (PCL) to form an X within the knee joint, and together, they control the front and back motion of the knee.

The ACL is injured far more commonly compared to the PCL. Injuries can happen when there is a pivoting injury, for instance, when athletes change direction rapidly, stop suddenly, or land from a jump incorrectly. Injuries can also happen when there is direct impact on the outer part of the knee, for example, in a football tackle.

Athletes who tear their ACL often feel a ‘pop’ and their knee may swell suddenly (due to bleeding from the torn ligament). There may be a sharp pain in the knee that limits their ability to continue playing or walk. When the knee swelling eventually subsides, the affected knee may feel unstable when the athlete returns to sports. The athlete is at risk of suffering another ACL injury as well as other serious injuries to the knee, such as meniscus and cartilage injuries.

When you visit Dr Seng, he will usually ask you about the mechanism of the knee injury. Some clues on physical examination may reveal the presence of an ACL injury. These include knee swelling, inability to straighten the knee fully, and the presence of instability on provocative tests. An MRI (magnetic resonance imaging) scan can be arranged to confirm an ACL tear and other associated injuries.

ACL tears are not usually repaired stitching because repaired ACLs generally do not have good success rates over time. Therefore, the torn ACL is generally replaced by a substitute graft made of tendon, which may be either come from the patient’s patellar, hamstring, or quadriceps tendon or in the form of allografts from a tissue donor.

ACL reconstruction is recommended in the following patient groups:

• Athletes who desire full range of movement, and return to active sports
• High grade tears of the ACL with clinical and functional instability
• ACL injury with concomitant injuries of the menisci, cartilage and other ligaments of the knee (medial, lateral, or posterior cruciate )

The surgery is usually done under general anaesthesia , so the patient will be asleep during the procedure. Analgesia will be given while the patient is asleep to alleviate the pain upon waking from anaesthesia. These include a combination of opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol and nerve blocks.

After surgery, the patient will be able to commence rehabilitative exercises with the physiotherapist on the same day of surgery. Intermittent icing of the knee joint also helps reduce the pain and swelling after surgery. The patient may need to use crutches to move about for the first 4-6 weeks after surgery to reduce weight-bearing on the operated leg. The knee may also be braced to limit the range of movement, especially when there is concomitant cartilage and meniscus repair.

In general, full return to sports may take 9 months. Earlier return to active sports may increase the risk of rupture, and hence should only be undertaken after clearance by the surgeon.

Many famous professional athletes who have suffered an ACL tear have been able to resume their careers successfully after an ACL reconstruction. With the right treatment so can you!