Anterior Cruciate Ligament Reconstruction is one of the commonest procedures Mr. Clifton performs after knee arthroscopy and total knee replacement.
This information sheet is for people who are planning to have an anterior cruciate ligament (ACL) reconstruction, or who would simply like to learn more about the procedure.
An ACL reconstruction involves replacing the anterior cruciate ligament in the knee. It's done to improve the stability and the function of the knee, often after an injury. It does not prevent the development of osteoarthritis but a stable knee will minimize future meniscal injury and give you the best chance to perform pivoting sports e.g. football.
The anterior cruciate ligament (ACL) is a strong ligament that runs through the centre of the knee. It is one of the main restraining ligaments of the knee. It controls the stability and the movement of the knee. The ACLs main role is to keep the knee stable during rotational movements like twisting, turning or sidestepping activities. It's usually damaged by twisting or overextending the knee, often combined with slowing down very quickly, especially during sports. The common causes are football and skiing. A popping sensation can often be felt or heard and immediate swelling often occurs due to bleeding into the knee (a haemarthrosis). Other injures to the knee can occur at the same time including meniscal tears (cartilage) or damage to the joint surface. The ACL also provides important information to the muscles around the knee (proprioception), which are involved in protecting the knee during activities. These 'balancing' mechanisms are reduced when the ACL is injured although some of this function can be restored with an appropriate exercise programme supervised by a sports physiotherapist.
Isolated injury to the ACL most often leads to a feeling of instability or giving way. Other people suffer with swelling and pain especially with twisting activities. A small number of people become so unstable that even simple activities may cause giving way.
ACL reconstruction involves replacing the anterior cruciate ligament of the knee with a graft. The graft is usually a section of tendon taken from another part of your knee, but sometimes it's a donor graft (allograft). At the moment, synthetic grafts are not recommended.p>
Mr. Clifton's preferred graft of choice is 4 strand hamstrings. In some patients these are not present (due to previous surgery) or unsuitable and then a bonepatellar tendon-bone graft is used.
The operation is normally performed using a narrow, tube-like telescopic camera called an arthroscope. This means that Mr. Clifton will only make several small cuts to examine the inside of the knee and to replace your torn ACL. Getting the donor graft will also need one or two additional small cuts in the skin.
For some people, ACL reconstruction isn't necessary. Knee instability can often be managed by appropriate physiotherapy, maintenance exercises and by stopping vigorous sports. However, if your symptoms interfere with your everyday life and sporting activities, and physiotherapy hasn't helped, ACL reconstruction is an option. It is unusual to be able to return to twisting sports such as football without an ACL reconstruction.
Mr. Clifton will explain how to prepare for your operation. The best thing you can do is to keep the knee muscles built up as much as possible and maximize your pre-surgery range of movement. Other things can help with your recovery, for example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
ACL reconstruction can be done under general anaesthesia, which means that you will be asleep during the procedure, often but not always, with an overnight stay. If you're having a general anaesthetic, you will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.
At the hospital your nurse may check your heart rate and blood pressure, and test your urine.
Mr. Clifton will ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
A number of small incisions (usually less than 10mm long) are made in the skin over the knee that is being treated. Your surgeon will insert the arthroscope and other surgical instruments into the knee through these cuts. Sterile fluid is put into the joint to help extend the joint and get a clearer picture of the inside of the joint. Mr. Clifton will then debride the torn ligament and prepare the knee for the replacement graft.
A graft will usually be taken from part of your hamstring tendon or from your patella tendon, which connects your knee cap and shin bone. Mr. Clifton will then drill a tunnel through your lower thigh bone (femur) via a key-hole portal and then drill a tunnel up through your upper shin bone (tibia).
The graft will be inserted in the tunnel, attached to the bones and fixed in place, usually with screws in the tibia and a special flip button in the femur. The incisions are closed with stitches or adhesive strips. The operation usually lasts one to two hours.
You will need to rest until the effects of the anaesthetic have passed. General anaesthesia temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.
When you feel ready, you can begin to drink and eat, starting with clear fluids. Dressings will cover the small wounds and a bandage will support your knee and help to control swelling. You will be encouraged to move your knee soon after surgery to stop the joint becoming stiff.
You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.
Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.
You will also see a physiotherapist who will give you some exercises to do while you recover. The amount of physiotherapy you need varies, so follow the advice of your physiotherapist and surgeon.
It can take between six and 12 months for you to recover your knee function after an ACL reconstruction. However, this depends on the individual so you should follow Mr. Clifton's advice on returning to your usual physical activities and sports. You must also follow your surgeon's advice about driving and returning to work. You shouldn't drive until you're confident that you could perform an emergency stop without discomfort.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice. You can also apply ice packs (eg frozen peas wrapped in a towel) to your knee to help reduce any pain and swelling. Don't apply ice directly to your skin as it can damage your skin.
Anterior cruciate ligament reconstruction is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
These are the unwanted but mostly temporary effects you may get after having the procedure.
You should expect some pain, stiffness, swelling and bruising around your treated knee. This is likely to last for some weeks and will gradually improve as the knee heals and as you get back to your normal day-to-day activities.
Complications are problems that occur during or after the operation. Most people aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis).
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Conscious, professional takes time to explain the procedure and put the patient completely at ease. Post operative I was fully informed of how the procedure went and what to expect in the way of pain and discomfort. In my case I did not suffer much pain, this I put down the skill of the surgeon. The discomfort was well managed, and I found the experience to far less daunting than I expected, again I put this down the the surgeon and his team. My last consultation was a pleasant and informative experience. I have total confidence in Mr Rupert Clifton. I have not had much experience of hospitals and surgery but if they are all like this why worry? I can see no way the service can be improved.
Written by a patient
Mr Rupert Clifton puts you at ease the minute you walk into his office. When it came to having my knee op I was a little scared as I don't like hospitals but should I have to have my other knee sorted then Mr Clifton will be my choice, it was a nice experience and I think that comes from not only Mr Clifton but also his staff. Excellent service.
Written by a patient
An excellant service, I was always kept well informed and made to feel safe and well, my new knee feels like it is my own but pain free with almost no signs of the operation scar. I would recommend Mr Clifton to anyone needing surgery and I would not hesitate to have any further surgery carried out by him but hopefully this will never be required.
Written by a patient
Although it is now several weeks since my appointment with Mr Clifton I would like to say how good it was to be treated with respect and as a real person. My treatment was excellent and very successful, saving me a serious operation. I cannot praise Mr Clifton enough.
Written by a patient
Mr Clifton was very attentive at all times and explained the procedure of my operation in great detail and listened to my concerns and questions. He also made me feel at ease in his manner that gave me the confidence to ask questions. As a patient it is very important to feel looked after and Mr Clifton had an extremely warm but professional manner which made me feel that I was in good hands.
Written by a patient