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 (shin bone) and crosses over in front of the femur (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.
In high-risk sports that require cutting, pivoting and jumping, the ACL plays a vital role in stabilising the knee joint and keeping 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.
The most common injuries of the ACL are ACL sprain or ACL Tear. ACL sprain is the stretching or tearing of some fibres in the ligament. On the other hand, an ACL tear is the complete rupture of the ligament. 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. Whether it’s a partial tear or a complete rupture in your anterior cruciate ligament, visiting an orthopaedic specialist in Singapore is critical so you can get suitable treatment for your injury.
What Causes an ACL Injury?
While repetitive strain injuries are common for athletes, an ACL can be a serious problem for any individual, especially if it’s an ACL tear, as it can debilitate them for months. The common causes of an ACL injury include:
- A result of a sudden stop
- Direct impact against another player or
- Landing awkwardly after jumping high
- Rapid changes in direction
This type of injury is common in contact sports such as football, soccer, and 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. Therefore, finding the right orthopaedic specialist or sports injury doctor in Singapore is crucial for optimal recovery.
What Are the Symptoms of an ACL Injury?
Following an ACL injury, you may experience the following symptoms:
- Pain in the centre of your knee
- Pain in the back of one's leg
- Swelling around the knee joint
- Instability when walking or changing direction quickly
- Difficulty squatting down without putting weight on their knees
If you suspect that either an ACL sprain or ACL tear has occurred, it is crucial to get immediate medical attention. That way, the full extent of your condition can be determined by an orthopaedic surgeon in Singapore who is trained in treating orthopaedic injuries.
How Is an ACL Injury Diagnosed?
An orthopaedic specialist in Singapore will offer a diagnosis of your ACL through history and physical examination. During the physical examination, the specialist will assess the amount of motion present and check if the ACL is torn. At the same time, they will examine the other structures within the knee since ACL tears are associated with damages to structures in the knee, like collateral ligaments and cartilage.
You will also undergo X-rays to see if there are any fractures. Some patients may even be required to get magnetic resonance imaging (MRI) should their history and examinations be inconclusive. Additionally, MRI examinations can also help the orthopaedic specialist evaluate the state of the cartilage and meniscus tissue so that you can get the right treatment for your condition.
Generally, your ACL injury will be categorised based on the extent of the injury:
- Grade 1 - The ACL has mild damage and is slightly stretched. However, it is still capable of keeping the knee joint stable.
- Grade 2 - The ACL is stretched to the point where it becomes loose. It is also considered a partial ligament tear.
- Grade 3 - With this type of injury, there is a complete ACL tear or pulled directly off the bone. This results in the knee joint being unstable.
How Are ACL Injuries Treated?
An ACL specialist in Singapore will determine your treatment based on your symptoms, health examination results, sport and activity goals (if any), and growth that remains in your growth plates.
Non-surgical treatment is appropriate for grade 1 ACL injuries, which are typically ACL sprains. This usually involves rest, ice, compression and elevations (RICE). Most partial ACL tears, grade 2, can be treated with physical therapy. Surgical intervention, on the other hand, involves ACL reconstruction to avoid long-term problems or wearing a brace that supports your knee joint. Surgery is generally recommended for ACL injuries with complete tears and unstable knees.
When Is an ACL Reconstruction Surgery in Singapore Necessary?
When a patient has a completely torn ACL and is experiencing functional instability, an ACL reconstruction surgery may be recommended, especially if it affects their ability to physically function. Getting ACL reconstruction is advisable if the unstable knee could lead to other possible joint problems. It is also recommended if you experience other injuries due to repetitive instability episodes.
With surgical intervention, you may be able to regain your full range of motion and live a more optimal quality of life in the long run.
How to Prepare for Your ACL Surgery in Singapore
When going to the orthopaedic clinic for your surgery, make sure that you are fully prepared for your surgery. Here’s a list of things you need to consider before your operation:
- Research about the procedure - Make sure to get as much information as you can about your ACL surgery. You can also ask your surgeon if you’re unsure about anything.
- Be transparent about other medical problems - Before your procedure, disclose to your ACL surgeon any other health conditions you may have and make sure that they will be under control on the day of the surgery.
- Avoid eating before the operation - It is safer to receive anaesthetics with an empty stomach. Therefore, you may be advised to fast before your operation.
- Arrange help and transport - It’s recommended that you have someone escort you to and from the hospital so that you can ensure your safety post-surgery.
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 with the recovery.
Possible Risks of an ACL Tear or Sprain
When you have an ACL injury, there’s a higher risk of osteoarthritis. Developing arthritis may even be a possibility, regardless of getting surgery to reconstruct the ligament. Several factors could increase your risk of arthritis, like the severity of your injury, other injuries in the knee, or the level of physical activity you perform after the treatment. Consult your ACL surgeon in Singapore to come up with a post-operation plan that will help you manage your injury in the long run.
Why Choose OrthofootMD for Your ACL Surgery in Singapore?
Finding the right ACL specialist for your injury is critical in your recovery journey. As an orthopaedic specialist in Singapore, OrthofootMD strives to help patients gain their physical functionality and independence with an evidence-based approach and individualised care.
We understand that no two cases are the same. Therefore, our specialist takes the time to get to know your health history and understand your condition, so you can get the treatment that you need to fully recover.
About Dr Gowreeson - ACL Surgeon in Singapore
Dr Gowreeson Thevendran is an orthopaedic surgeon in Singapore that specialises in orthopaedics and trauma surgery. His particular skill set is minimally invasive surgical techniques to treat foot, ankle, knee, and hip/thigh conditions. He pursued fellowship training for sports surgery at Chelsea & Westminster Hospital, UK and complex trauma and deformity correction at Royal Liverpool University Hospital, UK. He also continues to serve the Orthopaedic Department at Tan Tock Seng Hospital as a visiting consultant.
We Accept Insurance Plans
Orthofoot MD is on the panels of different health insurance plans. We also accept Medisave. To know if any of these health insurance partners can cover your ACL appointments or surgery, you can talk to the personnel at any of our clinics in Singapore.
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 injury, book an appointment with our orthopaedic surgeon as soon as possible. That way, you can manage the symptoms better and avoid severe injuries in the long run.
Dr Gowreeson Thevendran
MBChB (Bristol), MRCS.Ed, Dip. Sports Med.Ed, FRCS.Ed ( Trauma & Ortho. ), FAMS (Singapore)
- Orthopaedics and Trauma Surgery
- English, Malay, Tamil
- Bachelor of Medicine and Surgery, University of Bristol, England
- Fellow of the Royal College of Surgeons, Edinburgh
- Diplomate Faculty of Sports and Exercise Medicine, Royal College of Surgeons Edinburgh
- Fellow of the Academy of Medicine, Singapore
- SICOT PIONEER Founders Award 2020
- 2015 European Foot & Ankle Society ‘Best Podium Presentation’ Award
- 2013 Singapore Orthopaedic Association Junior Travelling Fellowship
- 2012 NHG Critical Talent Special Recognition Award
- 1998 Enid Lindt Prize in Clinical Surgery
- 1995 Public Services Department Full Medical scholarship
Frequently Asked Questions about ACL Tear & Reconstruction Surgery in Singapore
Here are some things you can do to protect your ACL from re-injury or more severe injuries:
- Stretching can help to warm up your muscles and prepare them for use. This can reduce the risk of injury significantly.
- Focus on strengthening your quadriceps muscles to keep your knees from buckling. Practising 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.
You can also ask your ACL surgeon in Singapore about other ways you can support your knee and prevent severe injuries.
The need to get an ACL reconstruction surgery will depend on the 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.
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.