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ACL injury (rupture)

ACL injury (rupture)

Injury to the anterior cruciate ligament (ACL) is a surprisingly common injury caused by a wide variety of activities including sport and trauma. The sports that are most commonly associated with ACL damage are those that involve pivoting and twisting, for example, football and skiing. Certain people are more pre-disposed to damaging their ACL, in this group of patients the force required to completely rupture the ACL can be quite minimal.

A complete rupture of the ACL can be associated with an increasing sense of instability as the knee recovers and the swelling settles. Although, in some patients, particularly those not involved in vigorous sporting activity, instability may never be noticed. However, where symptoms of instability do exist, at Schoen Clinic, we have a whole team of experienced knee experts who specialise in minimally invasive ACL reconstructive surgery to restore stability.

ACL rupture surgery: aftercare and recovery

In the immediate post-operative period, the priority is to reduce the swelling in and around the knee and this is done with the use of a Game Ready ice machine, this will be used both on the ward and at home for the first month following surgery. You can ask about how this can be hired, prior to the surgery.

Once the swelling settles you will concentrate on regaining a full range of motion, both actively and passively.

The post-operative programme is as follows:

  • Crutches are provided for a two week period, but the patient would be expected to stand unsupported.
  • You will walk once awake and be able to climb stairs within three to four hours of surgery prior to your discharge.
  • Physiotherapy begins on the day of the surgery and is crucial to the success of your operation.
  • The sutures are removed from the wounds after two weeks when you are reviewed for the first time by your surgeon.

The surgeons at Schoen Clinic work closely with the outpatient physiotherapists, whom we would expect to have a good knowledge of ACL reconstruction rehabilitation. In almost all cases, depending on where you live, we will be able to recommend a rehabilitation team to oversee your rehabilitation. We would expect you at two weeks to have seen your outpatient physiotherapist on at least three occasions. 

As the wounds settle, the priority changes from the range of motion to muscle strengthening and proprioceptive/balance work. Naturally, every patient recovers at a slightly different rate and there is no "normal" with respect to returning to sporting activity post-surgery.

At first, we recommend “closed chain “ exercises that do not create shearing forces across the knee, this is because the graft material is actually getting weaker for the first 10 to 12 weeks after implantation. As such we expect you to be able to cycle within the first month after surgery (closed chain ), although we would delay running (open chain), even on a treadmill, for up to five months.

This is required in order to give the graft material every opportunity to heal without producing micro trauma. 

The speed of recovery from this operation is limited by the ability of the body's own biology to integrate the graft material into the bony tunnels and thus become fixed.

The graft tissue, acting as a scaffold, is substituted by the body's own cells and this process can take anything between nine to eighteen months, to return to previous levels of strength.

Our team of surgeons at Schoen Clinic have an international reputation in this surgery and they regularly treat both amateurs but also elite sports-people from all around the world.

Most of our surgeons have a relationship with leading sports clubs and leading sports medical consultants in the UK, who can also advise on muscular optimisation techniques prior to returning to competitive sports.