ACL Reconstruction Surgery Sydney

ACL reconstruction surgery is a common surgical procedure. It restores stability to your knee if the ACL is ruptured.

You are most likely to benefit from reconstruction surgery if:

• You are young and want to remain active
• You want to keep playing sports that involve twisting, pivoting or rapid deceleration
• Your knee is unstable and gives way, or feels like it might, with normal day-to-day activities
• Your job is very physical or your knee giving way could be dangerous, such as building, firefighting, policing or emergency work

The surgery aims to give you a knee that you can trust when active. It can help you return to your chosen sport while reducing the risk of further damage to the knee from repeated instability episodes.

An ACL reconstruction is not usually emergency surgery. In fact, if it is carried out too quickly on a swollen and stiff knee, it can lead to a worse result. Operating on a knee that is not moving well can increase the risk of long-term stiffness.

It is vital that you work with your physiotherapist to regain a full and painless range of motion in your knee. This generally takes 10 days to three weeks from the injury, although it can take longer if there are other injuries.

Sometimes it is necessary to operate first on another injury, such as a bucket-handle meniscal tear, to allow the knee to move properly. The ACL reconstruction may then be performed several weeks later when the knee is ready.

It is also important to consider the full rehabilitation period and how the timing of surgery may affect family events, holidays, work trips, busy work periods, school exams, university finals or major sporting commitments.

At MTP Health, we take your preparation seriously. We want you physically strong, psychologically prepared and medically safe before surgery. We may organise additional tests or specialist referrals if needed.

Finally and importantly, we help you get strong. Our physiotherapists and exercise physiologists can assess your function, and we recommend booking your first post-operative physiotherapy appointment for two to five days after surgery once your surgical date is confirmed.

The hospital will contact you in the week of surgery and confirm your arrival time and fasting instructions, usually the day before your procedure.

For our patients, if you are on a morning list you usually need to stop all food from midnight and stop clear fluids from 5:30am or two hours before the planned start of the list, whichever comes first.

For afternoon lists, the food fasting time is usually 11am.

Acceptable clear fluids include water, see-through apple juice with no bits, or see-through sports drink such as Gatorade. Clear fluids do not include milk or cloudy juice with bits.

You will arrive at hospital between one and two hours before surgery and can usually go home on the same day. One of our anaesthetists will give you a general anaesthetic, meaning you will be asleep for the whole procedure. They may also place local anaesthetic around the nerves of the leg to reduce pain after you wake up.

Once you are asleep, the first step is harvesting the graft. In most cases, this comes from the hamstring tendons, but it can also come from part of the patellar tendon. To access the hamstrings, a small incision is made on the inside of your shin just below the knee joint. For the patellar tendon, an incision is made at the front of the knee from the kneecap toward the tibial tuberosity.

The graft is prepared with sutures and sized to suit your knee. A tourniquet may be inflated around the upper thigh to reduce blood flow and improve visibility during the arthroscopy.

Your surgeon then makes two to three small incisions at the front of the knee and fills the joint with sterile saline. A telescope, called an arthroscope, is inserted into the knee and attached to a camera. This allows the surgeon to assess the torn ACL and check for other injuries such as meniscal tears or cartilage damage.

The correct positions are measured and marked before tunnels are drilled into the femur and tibia. The graft is passed through these tunnels and fixed at either end with screws, buttons, staples or other fixation devices.

At the end of the procedure, the incisions are injected with local anaesthetic, closed with dissolvable sutures and covered with dressings. The surgery usually takes 30 to 90 minutes, with extra time before for anaesthetic and after for recovery.

Most patients experience little more than mild to moderate discomfort after waking from ACL reconstruction. Pain is usually controlled with medication for a short period.

After the operation, you wake in the recovery room, where you are monitored for approximately one hour. Once stable, you are transferred to the day stay ward. Your surgeon will usually contact your relative or support person, but they should be aware that this may be several hours after you were taken into theatre because of preparation and recovery time.

Walking — You will be given crutches before leaving hospital for safety. Following ACL reconstruction, most patients can put weight through the leg immediately and bend the knee as pain allows, unless an associated repair requires restrictions. Most people are walking comfortably by around two weeks.

Bracing — A brace is not used routinely. It may be used to restrict bending when there has been an associated meniscal repair, root repair or more complex reconstruction. In those cases, it may be worn for around six weeks.

Dressings — The bulky dressing around your leg can usually be removed the morning after surgery. Smaller waterproof dressings underneath should stay in place until your wound check at 10 to 14 days. Some fluid from inside the knee can ooze into the dressings over the first 24 to 48 hours and may have a faint red colour.

You can shower with waterproof dressings, but avoid soaking in the bath, pool or ocean. If dressings come loose or become soaked, they should be replaced.

Length of stay — It is usually safe to go home on the same day. If surgery is later in the day, or if there are additional procedures, it may be more comfortable to stay overnight and go home the next day.

Surgeon follow-up — Your first post-operative visit is usually at two weeks. This appointment is important for checking wound healing, assessing knee stiffness and answering your questions. Further reviews are usually arranged at six weeks, 12 weeks, six months, one year and then as recommended.

Your recovery starts the minute you are awake from the anaesthetic. Early exercises include pumping your calf muscles to encourage blood movement through the legs and contracting your thigh muscles to press the back of your knee into the bed. The physiotherapist will assist you with getting out of bed and walking.

It is vital to your recovery that you engage with physiotherapy to maximise your early recovery from surgery. At MTP Health, we recommend booking your first post-operative appointment with a physiotherapist as soon as your surgical date is confirmed. This should usually be between two and five days after surgery.

Your physiotherapist will help you manage swelling and stiffness before progressing leg strength and function. Later, your program will focus on your chosen sport or activity and reduce the risk of further injury.

The ACL rehabilitation protocol we use is based on years of research and experience. As a guide, we recommend physiotherapy twice weekly for the first six weeks, once weekly for the second six weeks, and one to two exercise physiology sessions weekly from three to twelve months.

The knee may remain swollen for up to six weeks, and the incision sites are often puffy and firm for up to three months. Recovery to the point where the knee feels relatively normal for daily activities usually takes around six months.

Driving

Returning to driving usually takes a minimum of six weeks for right knee surgery and around two weeks for left knee surgery in an automatic car. Regardless of time, you must be able to safely perform an emergency stop and must have stopped all painkilling medication other than over-the-counter medications such as Panadol or Nurofen. Please also check with your car insurance company.

Work

Most office workers can return to work after one to two weeks. Heavy manual workers may require two to three months before resuming full duties.

Sport

Returning to high-risk sports such as netball, soccer, footy, basketball and skiing takes a minimum of nine to twelve months. It requires consistent rehabilitation under the guidance of physiotherapy and exercise physiology.

Returning to sport earlier than nine months, or before achieving the strength, balance and function targets set by your team, increases the risk of graft failure or further ACL injury.

ACL reconstruction surgery is generally a safe procedure, but all joint surgeries carry some general risks. The most common side effects are temporary pain, bruising, swelling and stiffness.

Blood clots — Blood clots are uncommon after ACL surgery but can cause calf swelling and pain. A clot in the leg is called a deep vein thrombosis, or DVT. Rarely, this can travel to the lungs and cause a pulmonary embolism.

Graft-site pain — You may feel pain or discomfort where the graft was taken, such as the hamstring or patellar tendon area. This is usually manageable with pain relief and improves over time.

Infection — Infection is very uncommon. A superficial wound infection may require antibiotics. If infection enters the knee joint, further surgery may be needed to wash out the joint.

Skin numbness — Small nerve fibres in the skin are often cut during surgery, leaving a small numb patch around the scar or outer part of the leg. This usually shrinks over time, although some numbness can persist.

Joint stiffness — Most patients are stiff after ACL surgery. This usually settles over days to weeks, but excessive internal scarring, called arthrofibrosis, can occasionally cause longer-term stiffness.

Graft rupture — The reconstructed ligament is vulnerable during rehabilitation, especially if excessive force is placed on it too early. The risk is higher in people returning to pivoting and high-impact sport. If the graft ruptures, revision ACL reconstruction may be needed.

Other uncommon complications include anaesthetic risks, allergic reaction to medications, nerve or blood vessel injury, heart complications and stroke.

As always with the health system, the answer is: it depends.

At MTP Health, our aim is to simplify healthcare through a better understanding of the system upfront. You can discuss the options specific to you with the team when you see your specialist.

If you are having surgery using private health cover, the standard fees for the surgeon, anaesthetist and assistant usually lead to a total out-of-pocket payment of around $4,500. This is the gap left after Medicare and your health fund have paid their rebates.

The anaesthetist is an independent practitioner and can charge a different gap, which may affect the final figure. We always provide their details and recommend checking their quote before committing to surgery.

The surgeons at MTP Health participate in various reduced-gap schemes run by different health insurance providers. Please check availability of surgical time slots first, as there may be a longer wait for this option.

Your insurance may also have an excess to pay, commonly around $500. If you are having the operation through the public system, there is no out-of-pocket surgical cost, but you may need to wait up to a year depending on hospital availability and urgency category.

Some people can manage an ACL tear without surgery, especially if they do not play pivoting sports and their knee feels stable after rehabilitation. This is usually called non-operative ACL management.

Surgery is more likely to be recommended when the knee keeps giving way, when you want to return to twisting or pivoting sport, or when instability could damage the meniscus or cartilage. The right choice depends on your age, sport, work, symptoms, knee stability and associated injuries.

ACL reconstruction replaces the torn ligament with a tendon graft. This remains the most common operation for ACL rupture, especially when the ligament is torn in a way that cannot reliably heal.

ACL repair attempts to reattach or preserve the torn ligament in selected tear patterns. It is not suitable for every ACL injury. Your surgeon will explain which option is appropriate based on the type of tear, tissue quality, timing and associated injuries.