In high-risk sports that require cutting, pivoting and jumping, the anterior cruciate ligament (ACL) plays a vital role to stabilise the knee joint and keep it in place. Running diagonally in the middle of the knee, the ACL prevents the tibia from sliding and offers rotational stability for the knee so that movement remains optimal. However, this also makes it one of the more commonly injured ligaments of the knee. ACL injuries such as an ACL sprain or tear can result in significant pain, disability and loss of function.
When an ACL tear happens, the lower leg bone may slide forward and most would hear a “pop” in the knee. While a range of symptoms can follow after an ACL tear, a swollen knee is usually expected after the injury. Ranging from a partial tear to a complete rupture in your anterior cruciate ligament, an orthopaedic specialist will examine your condition further and discuss the relevant treatment options with you. Depending on how the ACL was injured, treatment may consist of non-surgical measures – such as rest, ice, compression and elevation –, surgical intervention with reconstruction or wearing a brace that supports your knee joint.
How Anterior Cruciate Ligament (ACL) Surgery is Performed
A general anaesthetic is first administered before the surgery. This will put you to sleep throughout the entire procedure. From there, the ACL surgeon will use knee arthroscopy to remove the damaged ligament. This is done by making a few small incisions – usually two or three – around the knee. They will then replace the ligament with a graft tendon, which is usually obtained from another part of your knee. Once this is performed, steri-strips may be applied to cover the incisions. The surgery can take about two hours, after which you may return home on the same day.
For ACL reconstruction in Singapore, it will usually require up to six months of recovery before you may resume any sports activities. During this time, do note that you will need to follow specific rehabilitation instructions given by your ACL surgeon to help ensure a successful outcome.
When is an ACL Reconstruction Surgery Necessary?
With ACL injuries, the degree of damage, and instability brought about by the symptoms and the pain experience will differ from patient to patient. While the swelling and pain in the knee may gradually subside without proper treatment, you may continue to feel unstable and buckle while walking. Most partial ACL tears can be treated with physical therapy and rehabilitation. However, in the case of complete tears, you may consider surgical intervention to regain the full range of motion in your knee. Getting ACL reconstruction may also be advisable should the unstable knee lead to other joint problems or if one experiences other injuries due to repetitive instability episodes. Therefore, when a patient has a completely torn ACL and is experiencing functional instability to the point where it affects their daily lives, to prevent the risk of developing any other secondary knee damage, an ACL reconstruction surgery should be considered over non-surgical treatments.
Consult an ACL Surgeon in Singapore
Our trained orthopaedic foot and ankle specialist at Orthofoot MD is committed to finding the appropriate treatment for your knee. If you suspect that you have an ACL tear, it is important to book an appointment and schedule your ACL reconstruction surgery quickly before the injury worsens. Get in touch with Dr Gowreeson today for more information.
Frequently Asked Questions about ACL Reconstruction in Singapore
1. Where is the anterior cruciate ligament (ACL)?
The anterior cruciate ligament (ACL) is one of the four major ligaments that provide balance when you walk, run or jump. It connects to both sides of the tibia, or shin bone, and crosses over in front of the femur or thigh bone. The ACL’s primary role is to prevent excessive motion between these bones when a person bends their knee.
Without an intact ACL, there would be little stability in your knee joint which can lead to pain and injury.
2. How does one injure their anterior cruciate ligament (ACL)?
While repetitive strain injuries are common for athletes – whether amateur or professional –, an ACL tear is a more serious problem that can debilitate a person for months. It usually occurs as a result of a sudden stop, direct impact against another player or landing awkwardly after jumping for something high up like a ball. Rapid changes in direction can also put a lot of stress on the ACL when it's twisted or stretched too far.
This type of injury is common in contact sports such as football, soccer, basketball as well as recreational activities like skiing. Once you tear your ACL, it can be hard for the ligament to heal on its own.
3. Where do you feel ACL pain?
Following an ACL tear, you may experience pain in the center of your knee. Symptoms of an ACL injury also include pain in the back of one's leg, swelling around the knee joint, instability when walking or changing direction quickly, and difficulty squatting down without putting weight on their knees.
4. How do I know if my ACL is torn or sprained?
An ACL tear and ACL sprain are both injuries to the anterior cruciate ligament in the knee. They can cause pain, swelling, stiffness, instability and difficulty walking or moving around.
The difference between an ACL tear and an ACL sprain is the degree of injury. An ACL tear is a complete rupture of the ligament, while an ACL strain refers to the stretching or tearing of some fibers in the ligament. ACL reconstruction will be recommended to avoid long-term problems.
Most importantly, if you suspect that either type of injury has occurred, it is crucial to get immediate medical attention so that the full extent of your condition can be determined by an ACL surgeon in Singapore who is trained in treating orthopaedic injuries.
5. Does stretching help prevent ACL tears?
There are some things you can do to protect your ACL from getting injured. Stretching, for starters, can help to warm up your muscles and prepare them for use, which can reduce the risk of injury significantly. During this time, you may focus on strengthening your quadriceps muscles to keep your knees from buckling. Practicing balance exercises on one leg will also help maintain stability in that area.
You may also consider wearing an appropriate brace when playing sports. The right brace will keep your knee in place so you don't put as much pressure on it while running or jumping. Finally, wearing proper footwear is imperative for maintaining good foot alignment.
Do note that after undergoing ACL reconstruction surgery in Singapore, it is still possible to tear an ACL again so these are good habits to maintain in the long run.
6. Is it okay to walk on a torn ACL?
Depending on the severity of the symptoms, most individuals will be able to walk after the pain and swelling subside. However, it is best to seek the advice of an orthopaedic foot and ankle specialist who can provide the clearance to walk after an ACL tear. While walking may still be okay, the typical turning, twisting or pivoting of the knee joint should be avoided as this can lead to further damage and secondary injuries to the knee.
7. Is it worth getting an ACL surgery?
The need to get an ACL reconstruction surgery is highly dependent on the extent of damage to the ACL. If the knee retains some level of stability and the patient does not lead an active lifestyle, getting the ACL surgically reconstructed may not be necessary. However, if the ACL tear has brought about secondary knee damage and is affecting one’s quality of life, delaying the ACL surgery can cause further damage. As such, it is best to consider seeking the advice of an orthopaedic surgeon and have them assess if there is a need for ACL reconstruction surgery.
8. Is ACL repair a major surgery?
Yes. Although a patient can go home after the surgery, an ACL reconstruction surgery takes about two hours and general anaesthesia is used during the reconstruction. Full recovery post-ACL reconstruction surgery can take up to 6 months, of which, a couple of weeks will have to be spent using crutches to offer support while walking.
Dr Gowreeson Thevendran is currently an orthopaedic surgeon with Island Orthopaedic, a one-stop care centre for orthopaedic health under Healthway Medical Group. He specialises in treating lower limb orthopaedic conditions, as well as trauma and fracture surgery of both the upper and lower limbs. Prior to establishing his private practice, Dr Gowreeson was Chief of Foot & Ankle Surgery at the Department of Orthopaedics at Tan Tock Seng Hospital (TTSH). Today, he continues to serve the Orthopaedic Department at TTSH as a visiting consultant.