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The anterior cruciate ligament (ACL) is one of the primary stabilising ligaments of the knee. It connects the thighbone to the shinbone and controls rotational stability- the kind needed for pivoting, cutting, and change of direction movements.

How does the ACL get injured

Most ACL injuries occur without contact. A pivoting or cutting movement during sport is the most common mechanism. A tackle that drives the knee inward is another. At the time of injury a pop is often felt, followed by rapid swelling and difficulty weightbearing. Associated injuries to the meniscus or other ligaments are common and will be assessed as part of your workup.

When is surgery recommended

Not every ACL tear requires surgery. Patients who do not wish to return to pivoting sport can often be managed non-operatively with physiotherapy and activity modification. Surgery is recommended for patients who want to return to pivoting sport, younger patients with high activity levels, and those whose knee instability is affecting daily life or work.

ACL reconstruction is not an emergency procedure. In most cases a period of prehabilitation-  physiotherapy to reduce swelling and restore movement-  is recommended before surgery.

The procedure

ACL reconstruction replaces the torn ligament with a graft. Dr Scaife uses hamstring tendon grafts for the majority of patients, offering faster recovery, less postoperative pain, and good long term outcomes. Other graft options including patellar tendon and quadriceps tendon are available and will be discussed at your consultation.

Surgery is performed arthroscopically under general anaesthetic as a day procedure. The graft is passed through tunnels drilled in the tibia and femur at the anatomic position of the ACL and fixed in place with specialised implants. Any associated meniscus injuries are addressed at the same time.

Recovery

Most patients are discharged the same day. Crutches are used for approximately one week. Stationary cycling begins at two weeks, straight line jogging at three months, and sport-specific training at six months. Return to sport is typically between nine and twelve months depending on recovery, associated injuries, and age. Rehabilitation with a physiotherapist is essential throughout and should be organised prior to surgery.

Follow up

Postoperative appointments are scheduled at two weeks, eight weeks, six months, and twelve months following surgery.