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

Procedures: ACL Reconstruction And Meniscal Repairs

Anterior Cruciate Ligament (ACL) reconstruction

Anterior-cruciate-ligament (ACL) tear

After an ACL rupture, patients are encouraged to undergo a rehabilitation programme aimed to reduce their knee swelling, control their pain, and maintain good movement of the knee and muscle strength. Though uncommon, there have been cases of people functioning well without an ACL, even performing normal daily activities such as walking and gentle jogging.

Problems may begin to arise when these activities are heightened, often twisting and torqueing the knee. This is when an ACL-deficient knee becomes unstable and painful. The instability may also cause your meniscus to tear and strain other ligaments around the knee. If the symptoms worsen despite adequate rest and medication, it is advisable to seek help from an orthopaedic surgeon.

Often, we receive young patients undergoing ACL reconstruction surgery, and only requiring general anaesthetic (GA) for their surgery. Once they are under GA, an arthroscopic (keyhole) assessment of their injured knee will be performed to determine the problems in the knee. It is common to find concurrent meniscal or cartilage injuries in the knee which can also be resolved during the surgery.

an arthroscopic (keyhole) assessment

How is ACL reconstruction performed?

There are numerous ways in which the ACL is reconstructed. Open surgical techniques for ACL reconstruction were the gold standard in the past. Today, minimally invasive and arthroscopic techniques are preferred among orthopaedic surgeons as the scars are smaller, promoting faster recovery and lowering the risk of infection.

Part of the old ACL is shaven off using arthroscopic instruments, and the ACL will be reconstructed using the patient’s hamstring tendons. A small vertical incision is made to harvest their hamstrings from the same leg, which are folded to form a four-strand hamstring tendon graft. The hamstrings are then bound together with sutures to form a robust new ACL graft.
keyhole surgery-knee
Biomechanical studies have shown that the new ACL graft is 70% stronger than the normal ACL at the time of implantation. The new ACL graft is pulled through a bony tunnel made in the top of the tibia bone as well as the end of the femur bone. After, it is secured in place with strong implants to stabilize the knee. The endobutton implant in the femur is made of titanium and is permanent. The interference screw in the tibia is made of polyether ether ketone (PEEK), a bio-absorbable material that is MRI-compatible.
ACL reconstruction_2
There are other methods of ACL reconstruction. Some surgeons use parts of either the patella tendon or quadriceps tendon in the knee to form the new graft.

These techniques may work for some, but are associated with fractures of the patella and cause patella pain when patients kneel on the floor.
The ACL can also be reconstructed using two separate grafts through two separate bone tunnels through the tibia and femur each, but these carry a risk of fractures around the bone tunnels, causing the reconstruction to fail. Using an allograft (tissue from an organ donor) can also lead to a higher risk of rupture, especially in younger patients.

Ultimately, the use of hamstring tendons from the patient (autograft) and performing surgery through arthroscopic and minimally invasive techniques is a widely-adopted method, and a popular technique across the world.

What is the recovery like?

Rehabilitation after ACL reconstruction surgery is crucial to your recovery and is split into several 2-week phases. The following are types of goals in the respective phases of rehabilitation.

Phase 1


  • To control pain and reduce the swelling in the knee
  • Maintain the strength of your quadriceps tendon
  • Early range of motion of the knee

Phase 2


  • Improving the movement of your knee (extension and flexion)
  • Removal of sutures
  • Gait training and muscle strengthening
  • Return to work

Phase 3


  • To achieve a full range of motion of your knee
  • Good strength in the operated knee, similar to the non-operated knee

Studies have shown that the ACL graft is at its weakest in the 6 to 8-week mark and may reach failure loads of 50% after the first year post-surgery. During the rehabilitation, the body treats the new ACL graft like a foreign object and tries to break it down one cell at a time, hence the prolonged phases at 2-week intervals. After about 6 to 8 weeks, new blood vessels are formed and develop cells to break down the ACL.
 
With adequate and appropriate physiotherapy and rehab, you may return to high impact, pivoting sports about 1 year after ACL reconstructive surgery. It is also important to understand that these rehabilitation exercises are best conducted in a controlled and protected environment. Patients are highly advised to not return to contact or pivoting sports such as football, basketball, and volleyball for about 12 months after surgery. This can cause new ACL graft rupture if patients return to sports too soon.

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