3 Mount Elizabeth, #08-05 Mount Elizabeth Medical Centre, Singapore 228510 | Tel: +65 6733 4565 | Mobile: +65 9766 4565 | Email: clinic@orionortho.sg

Procedures

What You Need To Know About Getting An ACL Reconstruction in Singapore

acl-reconstruction-in-singapore

Introduction

We have two cruciate ligaments in each knee, the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). They are situated in the middle of our knees connecting our femur and tibia bones together. The ACL provides stability to our knees when we twist and pivot during daily activities and strenuous sports. The ACL itself is an extremely strong structure but can still rupture if excessive force is applied to it! This happens in sports that involve sudden stops or changes of direction at speeds while the foot is firmly planted to the ground; football, basketball, and skiing to name a few.

How do I know if I have suffered an ACL rupture?

Many patients hear a ‘pop’ or feel a popping sensation when they rupture their ACL. This may be associated with knee pain, swelling, and inability to walk due to instability. The initial treatment for ACL ruptures would be to rest, ice the knee and take some anti-inflammatory medications to ease the pain. Your orthopaedic surgeon will organize an MRI scan to confirm the diagnosis of a ruptured ACL and to exclude other associated injuries in the knee such as meniscus tears. It is crucial to undergo a course of physiotherapy and rehabilitation after an ACL rupture to maintain the strength of your quadriceps muscles and the flexibility of your knee. An unstable knee after an ACL rupture may lead to meniscal tears and arthritis in the medium to long term. It is common to require both ACL reconstruction surgery and meniscus repair procedures at the same time.

How can I prevent an ACL rupture during sports?

As an athlete, it is important to undergo strength training and maintain good muscle bulk and control. Strong muscles around a joint help prevent falls and sports injuries. It is critical to be in good physical condition before participating in contact or high-intensity sports. Appropriate sportswear also helps prevent injuries.

Here are some factors which may put one at risk of an ACL rupture. These include;
− Poor physical conditioning
− Participating in certain pivoting sports: basketball, football, volleyball, skiing
− Playing on artificial turf
− Poorly fitting or maintaining sports equipment
− Being female: due to differences in anatomy, strength, and hormonal influences

What is an ACL reconstruction?

Patients with ACL ruptures undergo ACL reconstruction to restore the stability and function of their knee. Surgery helps patients and athletes return to their active lifestyles and sporting hobbies. The ACL is reconstructed using a graft which may be obtained from a variety of sources. Autografts are tissue that is obtained from your own body while allograft is tissue taken from a donor.

○ Hamstring autograft
○ Bone-patella-bone autograft
○ Quadriceps tendon autograft

○ Tendon allograft

The type of graft used will depend on multiple factors including patients’ age, nature of physical activities and surgeon’s choice. Hamstring autografts are currently the most popular type of graft used worldwide and is the graft of choice at Orion Orthopaedic for primary ACL reconstructions. For patients who require revision ACL surgery because their graft has re-ruptured, Dr. Mizan will perform the surgery using cadaveric allografts.

When would an ACL reconstruction be required?

After the initial pain and swelling have subsided, most of my patients can still walk and do some amount of exercise even without an intact ACL. Sports such as brisk walking, gentle jogging, cycling and swimming are largely done in one direction and do not involve significant pivoting or twisting of the knee. If you mostly participate in such sports or only have a partial rupture of your ACL, then ACL reconstruction surgery may not be necessary for you. There is a significant risk of subsequent meniscus tears and cartilage degeneration in patients without an ACL due to the micro-instability which happens. 

If you intend to participate in lots of pivoting sports such as football or basketball, an intact ACL is crucial for you to maintain your balance and performance during sports. In such instances, an ACL reconstruction would be strongly encouraged.

I would prefer that my patients undergo good physiotherapy after their injury whether or not they have any surgery done. This is to help reduce the knee swelling and maintain the strength of knee stabilizer muscles (quadriceps, calf and hamstring muscles). A knee brace is also used to stabilize the knee; knees that are very unstable may lead to secondary injuries to the meniscus and cartilage. Many patients with ACL ruptures feel better after several weeks of physiotherapy and treatment. They may feel good enough to return to sports but may still experience instability in their knee. If they have decided to undergo surgery, a good time to perform ACL reconstruction surgery is when the knee swelling has significantly reduced and my patients have undergone some physiotherapy. This may take a month or two.
 

Will I also need to undergo a meniscus repair surgery?

ACL injuries and meniscus tears often occur together. If you suffer from a torn meniscus, a meniscus repair may be required. A successful meniscus repair procedure helps restore the integrity of the meniscus and allows it to function as a shock absorber and lowers the risk of future joint problems, such as osteoarthritis.

How does an ACL reconstruction work?

The ACL reconstruction surgery is performed by via arthroscopic or keyhole techniques. It takes about 90 minutes and patients are usually under general anesthesia.

Dr. Mizan will assess your knee joint through an arthroscope to confirm the complete rupture of your ACL and exclude any other injuries such as meniscal tears or cartilage defects in your knee. Once this is done, an accessory skin incision of about 3cm is made in order to harvest your two hamstrings (Semitendinosus and Gracilis). These hamstrings are prepared and used as your new ACL graft.

Two bone tunnels are made across the proximal tibia and distal femur to accommodate your new ACL graft. Once this is done, the graft is pulled through the tibia and femur tunnels before it is secured with implants at both ends.

Your knee will then be protected in a knee brace for the next 4 to 6 weeks as you recover from surgery.

acl-reconstruction-in-singapore
acl-reconstruction-in-singapore

What can I expect for my knee arthroscopy?

Arthroscopic surgery may be performed on an outpatient basis, meaning that you can be discharged and go home on the same day. Some patients prefer to stay for one night to ensure their pain is well controlled and they are able to walk with or without crutches. If your knee arthroscopy is performed under general anesthesia, you will be asleep during surgery. You may experience some pain in the joint from the small arthroscopic incision made to the knee.  This pain is generally well managed with simple oral medication.

What can happen if you don’t get appropriate treatment

An ACL-deficient knee may lead to instability and cause further injuries such as meniscal tears and cartilage damage. Patients participating in pivoting sports such as football or basketball may fall due to the instability of their knee. We would recommend that you seek an urgent orthopaedic consult if you suspect an ACL injury.

How much does an ACL surgery cost?

The ACL reconstruction surgery is Insurance/Medisave claimable. The cost of the surgery and hospitalization will vary depending on whether you have the surgery in a public or private hospital. Based on Ministry of Health guidelines, the approximate cost of ACL surgery and hospitalization in a private hospital is about $35,000. This includes doctors’ (surgeon and anaesthetic specialists) fees, facilities and operating theatre costs as well as implant costs.

 

Recovery after an ACL reconstruction

The ACL reconstruction surgery itself takes about 90 minutes and is done by keyhole or minimally invasive techniques. Patients receive a general anaesthetic and usually stay in the hospital for one night after their surgery. This is to ensure we manage any discomforts well with medication. We protect their knee in a knee brace and allow them to walk with the help of two crutches for about 4 to 6 weeks. Physiotherapy is a critical aspect of rehabilitation as it helps maintain the strength and function of the quadriceps muscles which in turn controls knee stability. Physiotherapy also facilitates a reduction in swelling and flexibility of the knee while it recovers from ACL surgery.

Week 1-2

− Regular icing and elevation to reduce knee swelling
− Use of a knee brace and crutches are imperative
− Passive movement of the knee
− Strengthening exercises for the quadriceps, hamstring and calf muscles

Week 3-4

− Improving gait and work towards walking with one crutch
− Passive and active movement of the knee
− Strengthening exercises for the quadriceps, hamstring and calf muscles

Week 5-6

− Use of the knee brace is progressively reduced
− Increasing the intensity of muscle strengthening, general movements of the knee
− Progression of exercises depends on muscle strength, pain and swelling

Week 10

− Forward, backward and lateral dynamic movements
− Isokinetic exercises

Month 3

− Functional exercises such as running, jumping
− Quicker changes in direction will be introduced as proprioception and coordination improves

Month 4-5

− Maximise endurance and strength of knee stabilizing muscles, improve neuromuscular control
− Increasing the intensity of muscle strengthening, general movements of the knee
− Acceleration and deceleration exercises with variations in running and turning

When can I return to contact and high-intensity sports?

We generally do not recommend returning to sports such as basketball or football for 10 to 12 months after surgery. The new ACL graft actually undergoes remodeling and change in the body about 6 months after surgery; this is when it is at its weakest. The next 6 months are important in strengthening the muscular knee stabilizers and preventing the new graft from re-rupturing.

For patients and athletes who participate in non-contact sports or activities that do not require a change in direction at speed, it is safe to return to these low-risk sports after good rehabilitation at about 4-5 months. Your physiotherapist and orthopaedic surgeon will give you specific advice based on your recovery and sporting activities

Possible complications of ACL arthroscopic surgery

Leg weakness and pain: this is often due to wasting and underuse of the quadriceps muscle over a period of time. We ensure that our patients resume their physiotherapy as soon as possible to prevent this from happening. Physiotherapy is an important facet of treatment for all patients with ACL ruptures, regardless of whether they have surgery or not.

Re-rupture of the ACL graft. It is important not to return to pivoting or high-intensity sports too soon as it may cause the new ACL graft to rupture. The body tries to break down the graft as it undergoes remodeling. During this time, the graft is at its weakest and should not be stressed. We advise our patients to only return to sports such as basketball and football about 12 months after their ACL reconstruction surgery.

While infection after an ACL reconstruction surgery is rare, we do take all precautions to prevent this. Our patients are asked to bathe in an antiseptic wash (chlorhexidine) the day before and the morning of surgery. This helps to rid the skin of bacteria. Our patients also receive prophylactic antibiotics before and after surgery since prevention is always better than cure. The small skin incisions also help reduce the risk of infection in our patients.

Are there other types of arthroscopic surgeries?

Aside from knee problems, arthroscopic surgery are key-hole techniques used to repair injuries in the shoulder, elbow, ankle, and hip. Common conditions that can be treated by arthroscopic surgery include shoulder rotator cuff and labral tears, ankle ligament tears and hip tears . Similar ACL reconstruction arthroscopy, arthroscopic procedures for the other areas are minimally invasive and may be treated as a day surgery procedure. Do consult your orthopaedic surgeon to find out if you are a suitable candidate for joint arthroscopy. Your surgeon will likely organise imaging such as X-ray, computed tomography (CT), ultrasound, and/or magnetic resonance imaging to determine whether arthroscopic surgery is required.

Conclusion

ACL ruptures are common sports injuries in athletes participating in pivoting or high-intensity sports. These injuries have to be managed well with conservative and surgical methods to allow such athletes a timely return to the sports they love. Reconstruction of the ACL has excellent results when done by an experienced surgeon and complemented by robust physiotherapy and rehabilitation.

Statistics

Factual sentences referenced across top search results:

  • In one study involving 122 athletes, over 90% were able to return to sport following ACL reconstruction. (doctorxdentist.com)
  • Infection – around 0.37% risk of infection. (doctorxdentist.com)
  • ACL graft re-tear – around 6% of patients may experience graft re-tear at 5 years. (doctorxdentist.com)
  • Infection – The risk of this is around 0.37% because patients are given antibiotics at the time of surgery the small incisions also minimize the risk of infection. (gaiaguides.com)
  • ACL graft re-tear – About 6% of patients may experience graft re-tear after a while( 5 years) (gaiaguides.com)
  • According to a large study involving 7556 patients undergoing ACL reconstruction, the majority were able to return to sports (81%). (ioc-ortho.com)
  • Two thirds of all patients were able to return to their preinjury level of competition, and 55 percent were able to return to elite level competition. (ioc-ortho.com)
  • The success rate of ACL reconstruction surgery is 95% in the country. (medigence.com)

Our Location

  • 3 Mount Elizabeth, #08-05 Mount Elizabeth Medical Centre, Singapore 228510
  • +65 6733 4565
  • +65 9766 4565
  • Mon-Fri 8:30am - 5:30pm
    Sat 8:30am - 12:30pm
    Sun/Ph Closed

Contact Form

Our Location

  • 3 Mount Elizabeth, #08-05 Mount Elizabeth Medical Centre, Singapore 228510
  • +65 6733 4565
  • +65 9766 4565
  • Mon-Fri 8:30am - 5:30pm
    Sat 8:30am - 12:30pm
    Sun/Ph Closed

Contact Form