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Information for patients
This patient information has been designed to provide you with some information about your surgery, recovery and rehabilitation, in addition to what your surgeon has already told you in clinic.
The Rotherham Hospital Knee Unit is dedicated to providing the best service for knee problems and injuries, using the latest techniques, evidence based surgery and rehabilitation.
The unit is led by two dedicated Orthopaedic and Trauma Consultant Surgeons, Mr Alex Anderson and Mr Andrew Legg who both specialise solely in the diagnosis and treatment of knee disorders including sports related injuries. Both have undertaken sub-specialty fellowship training in knee surgery.
The unit has considerable experience in knee arthroplasty surgery, arthroscopic meniscal surgery including meniscal repair, knee ligament reconstruction, as well as re alignment surgery for deformity.
We have the dedicated support of our team of physiotherapists, at Rotherham Hospital and at the Park Rehabilitation Centre, who have the specialist knowledge and experience to ensure you achieve the best possible outcome following your treatment.
Both Mr Anderson and Mr Legg are part of the National Ligament Registry. This is a national database that aims to help improve the management and outcome of knee ligament surgery. You will be asked if you are happy to consent to be part of the registry, and will receive an email from the NLR prior to your surgery with a link to questionnaires to be completed prior to your surgery. The same questionnaires will then be sent to you at 6 months, 12 months, 2 years and 5 years following your surgery. In addition your surgeon will input your operation into the registry.
If you would like more information visit the National Ligament Registry website.
The ACL is one of the main ligaments in the knee which runs through the centre of the knee from the back of the femur (thigh bone) to the front of the tibia (shin bone). It acts as a link mechanism to stabilise the knee, especially in twisting movements.
If the ACL has been torn, patients often complain of the knee giving way or feeling unstable. This operation gives you a new ligament which will stabilise the knee and help you to return to work and sport.
It is known from research studies that up to 90% of patients consider their knee to function normally or near normally after this operation. Some patients will also have damaged one of the menisci (cartilages) inside the knee. This will be treated at the same operation. It can take 9 - 12 months of rehabilitation after your operation for you to recover fully. It is essential that the physiotherapy rehabilitation program is completed and not cut short, to reduce the chance of rupturing the ACL reconstruction (graft) and to improve the chance for you returning to pre-injury activity level.
Most ACL reconstructions will be done as a daycase operation. This means that usually you will go home on the same day as your operation.
Most of the operation is done using keyhole surgery. Your surgeon will make a number of small skin incisions (cuts) around your knee and the operation is done through these.
Firstly, part of the hamstring tendons are taken from the inner part of the knee and these are used to replace the torn ACL. Alternatively the new ligament is made from a small piece of the kneecap (patella) and its tendon (patellar tendon). Your surgeon will discuss with you the benefits of each so you are able to decide the best option for you.
The rest of the operation is done from inside the knee. A hole (tunnel) is drilled into the femur (thigh bone) and tibia (shin bone) and the new ligament is passed through the middle of the knee into these holes and is fixed in place.
If you have a tear of a meniscus (cartilage) then this will be tidied up or repaired at the same operation. The small skin incisions (cuts) are closed with stitches and a well padded bandage is put on to cover the knee.
All operations have risks, but these thankfully are small with this operation. Your surgeon will discuss these with you before surgery.
This is treated with antibiotics.
Your knee will be swollen after the operation and this may take several months to settle.
This can be helped with physiotherapy.
Some people find that they cannot return to full sporting activities after surgery.
You may have skin numbness around the front of the knee and down the shin. This usually resolves within 18 months.
Blood clots can occur with any operation but are rare with this operation. You will be walking on the same day as the operation and this reduces the risk of blood clots.
If you have another injury you may damage the new ligament. Strengthening the knee with physiotherapy after the operation helps prevent this.
You will be seen by a nurse who will ask you questions about your health and any medication you are taking. This helps check that you are ready to have an operation. For you to go home on the day of the operation you must not have any significant medical problems, have a responsible adult to take you home by car and stay with you for 24 hours after the operation. If there are any concerns about your health you may be asked to see an anaesthetist for an assessment before you are given a date for surgery.
Your anaesthetist will see you on the day of surgery and discuss and explain the anaesthetic options. There are two main options:
You may be offered a saphenous nerve block in addition to your general or spinal anaesthetic for your pain relief after your operation. This is an injection at inside of your thigh to numb the main sensory nerve to your knee.
You will be seen by your surgeon again after pre-assessment and before the operation. The details of the operation will be discussed and you will be able to ask any questions you may have before signing the consent form.
The hospital will send you a letter before your operation with details of what time to arrive and where to go on the day of your operation.
Please follow the starvation instructions given to you at Pre-assessment or in the You and Your Anaesthetic information.
Your surgeon will see you on the day of surgery and check that you are ready. You can also ask any other questions about your operation which your surgeon will answer.
You will be seen by your anaesthetist to discuss your health and anaesthetic.
A physiotherapist will also see you before your operation. You will be shown how to use crutches in case you need them, and given general advice on how to look after your knee following your operation to help the swelling go down.
You will be taken to the Recovery ward from the operating theatre where a nurse will stay with you. You will be given strong painkillers if you need them. A special cuff may be wrapped around your knee that contains ice to help the swelling settle.
When you are back on the ward you will usually be given a light snack and a drink. You may also be given further advice from your physiotherapist on some exercises to do at home and the use of ice.
The nurses will telephone the person collecting you when you are ready to leave. You will be given some painkillers to take at home as well as details of your physiotherapy appointment and clinic appointment.
You should rest and follow the instructions given to you by the physiotherapist to help reduce the swelling and gently start moving your knee again. You can put all of your weight on your knee, using the crutches to help you balance.
Getting the movement back in your knee early after your operation is very important, and you will have to do your exercises every 4 hours. Full written instructions will be given to you. The bandages stay on for up to 2 days after your operation. It is important that you drink 2 litres of water a day as this helps prevent blood clots.
After your operation the physiotherapist will help you to recover. It is very important that you follow the exercises they give you as this will help you get the most out of the new ligament. You will be seen by your physiotherapist on a regular basis.
Regain movement in the knee, especially extension and let the swelling settle. Resting indoors for the first week is encouraged.
You will be gradually weaned off your crutches and you will start pool and gym based exercises.
You will progress with exercises in the pool and gym and usually around 8-12 weeks, depending on how quickly your knee recovers you will begin light jogging activities and cardiovascular work, and higher intensity training for balance and control.
You will continue with strengthening exercises in the gym and progress to more high intensity sport specific training e.g. running, cutting, accelerating, decelerating and turning activities under the close supervision of your physiotherapist.
You will progress to the final stages of your rehabilitation which will include sport specific drills. This is in preparation for your return to sport.
Full return to sport, but sometimes longer. Your surgeon and physiotherapist will tell you when it is safe for you to return to sport.
You can usually start driving after 6 weeks. Your surgeon and physiotherapist will confirm when you are safe to drive.
Recent studies have shown that the incidence of ACL injury can be reduced by up to 70% with the use of a specific warm up program before training.
The PEP program (Prevent injury and Enhance Performance program) was developed in Santa Monica by the Santa Monica Orthopaedic Sports Medicine Research Foundation. The program has 5 highly specific parts designed to improve neuromuscular conditioning and muscle reactions which decrease ACL injury:
Additional details can be found on the Santa Monica Orthopaedic and Sports Medicine Research Foundation website.