The anterior cruciate ligament (ACL) is often injured when playing sports. It helps to stabilise the knee and allow the joint to function (particularly when changing direction suddenly). The feeling of instability can prevent return to activities (including some sports) with subsequent episodes leading to further damage to the knee.

Reconstruction usually involves taking either hamstring tendons or part of the patellar tendon to form a new ligament. This then needs to heal in place, the muscles need to recover and the brain needs to learn how to use the knee again. 

Most patients have a general anaesthetic combined with local anaesthetic to control post-operative pain. 

The procedure usually takes 1-1.5 hours but may be longer if additional surgery is required to fix problems with the meniscus or other ligaments. With the anaesthetic and recovery this usually amounts to at least 2.5 hours.

The chosen graft is taken and then a key-hole procedure is performed to place the new ligament in the correct position and secure it there. The incisions are dependent on the graft chosen. The knee is filled with water and a camera is used to look around the joint. Additional injuries can be treated at the same time.

Incisions are usually closed with absorbable sutures and dressings applied. A bandage is applied to limit post-operative swelling. Occasionally, a brace is used (if additional surgery has been required).

Most patients stay for 1 night in hospital and benefit from seeing the physiotherapist the day after surgery.

The physiotherapy following this procedure is vital to the success of the operation. There are a series of phases that must be progressed through to maximise the chances of a good result.

Initially, the focus will be reducing the swelling and getting the knee moving again. Next, it is important to build up the strength (without over-stressing the new ligament). When healed, the new ligament can then be incrementally loaded with coordination and balance being key. Finally, patients can begin to build up to a return to sport. The physiotherapists are very experienced in guiding patients through this process. 

Most patients take about 9 months to progress through this with a return to competitive sport not advised until 12 months post-reconstruction.

Patients are routinely seen at 2 weeks (to ensure the incisions are healed), at 6 weeks (to ensure movement has returned) and at 3 months (to  check the new ligament is functioning well). Additional appointments are scheduled to coincide with progression of activities and return to sports.