ACL Reconstruction Surgery in Singapore

What is an ACL Injury?

An anterior cruciate ligament (ACL) injury is a tear or sprain of the anterior cruciate ligament – one of the major ligaments in your knee. 

ACL injury mostly occurs during sports that involve sudden stops or changes in direction, jumping and landing such as soccer, basketball, football and downhill skiing. 

When you tear an ACL, you may hear or feel a “pop” in the knee. Your knee may swell, feel unstable and become too painful to bear weight. 

Depending on the severity of your ACL injury, treatment may include rest and exercises to help you regain muscle strength and stability, or surgery to replace the torn ligament followed by rehabilitation.

Who is at Risk of ACL Injuries?

ACL injuries can happen to anyone, but especially:

• •Active individuals or athletes who participate in sports or competitions that involve quick changes in direction (such as football, badminton, pickleball, HYROX)
• •Women, due to biomechanics and hormonal influences
• •Those with previous knee injuries
• •Those returning to sport or heavy exercise after long breaks
• •Older adults, due to natural wear and tear in their joints and ligaments
• •Anyone with a history of knee injuries

How is an ACL Injury Diagnosed?

Your surgeon will conduct some tests to determine the severity of the injury as follows:

X-ray

To determine for bony injuries (fractures). However, X-ray does not show soft tissues such as ligaments or tendons.

MRI Scan

MRI of the knee to evaluate soft tissue damage (ligaments and cartilage).

Ultrasound

To check for injuries in the ligaments, tendons and knee muscles.

Treatment Options for ACL Injury

There are non-surgical and surgical treatments that one can consider, depending on your doctor’s assessment.

1. Non-Surgical Treatment

Non-surgical treatment may include: 

• Rest – General rest is necessary for healing and limits weight bearing on your knee.
• Ice – When you’re awake, try to ice your knee at least every two hours for 20 minutes at a time. 
• Compression – Wrap an elastic bandage or compression wrap around your knee. 
• Elevation – Lie down with your knee propped up on pillows.
• Physiotherapy – As the swelling goes down, a careful rehabilitation programme is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it. 
• Bracing – The surgeon may recommend a brace to protect your knee from instability. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.

2. Reconstruction Surgery 

Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament must be reconstructed. Your doctor will replace your torn ligament with a tissue graft. This graft acts as a scaffolding for a new ligament to grow on. 

Grafts can be obtained from several sources. Often they are taken from the patellar tendon, which runs between the kneecap and the shinbone. Hamstring tendons at the back of the thigh are another common source of grafts. Sometimes a quadriceps tendon, which runs from the kneecap into the thigh, is used. Finally, cadaver graft (allograft) can be used.

There are advantages and disadvantages to all graft sources. You should discuss graft choices with your own orthopaedic surgeon to help determine which is best for you.

Because the re-growth takes time, it may be six months or more before an athlete can return to sports after surgery.

ACL Surgery Recovery Timeline

Within the first few weeks after surgery, you should strive to regain a range of motion equal to that of your opposite knee.

You should be able to put your full weight on your operated leg without crutches 2 to 3 weeks after surgery; if the surgeon feels it is fine. Nevertheless, you will be able to ambulate with crutches after the operation.

Resumption of normal sports activity is variable and patient dependent. In general, acl reconstruction recovery time in Singapore takes approximately 6 to 9 months. Please discuss with your doctor with regards to this as different patient profile and various intraoperative factors may differ amongst patients.

Here are other tips to facilitate your recovery process:

1. 1) Take prescribed medications to help minimise the swelling and pain over the operated knee. The pain should subside gradually each day.

2) Walk around your home using a front-wheel walker, crutches or a cane (assistive walking device) as instructed by your physiotherapist.

3) Perform daily knee exercises recommended by your physiotherapist to regain muscle strength and improve the range of movements in the operated knee.

4) Keep the wound clean and dry at all times to prevent from any infection. Cover the operated knee with a waterproof protector when showering, as advised by your healthcare team.

5) Attend your post-op review appointments as recommended by the clinic, so that your surgeon can review the wound and monitor your recovery.

Risks and Complications of ACL Reconstruction Surgery

There are a couple of potential complications that may occur after ACL reconstruction surgery:

1. Lax and Unstable Knee: May be caused by graft disruption, including partial or complete tears, or ganglion cyst formation.

2. Decreased Range of Motion: May be caused by graft impingement, which can result from improper graft tunnel placement or the presence of bony spurs in the intercondylar notch.

How to Prevent ACL Injuries

Proper training and exercise can help reduce the risk of ACL injury. A sports medicine physician, physical therapist, athletic trainer or other specialist in sports medicine can provide assessment, instruction and feedback that can help you reduce risks.

Programmes to reduce ACL injury include: 

• •Exercises that strengthen leg muscles, particularly hamstring exercises, to ensure an overall balance in leg muscle strength 
• •Exercises to strengthen the core, including the hips, pelvis and lower abdomen 
• •Training and exercise emphasising proper technique and knee position when jumping and landing from jumps 
• •Training to improve technique when performing pivoting and cutting movements 
• •Training to strengthen muscles of the legs, hips and core — as well as training to improve jumping and landing techniques — may help to reduce the higher ACL injury risk associated with women athletes.

Frequently Asked Questions about ACL Surgery