ACL reconstruction – keyhole surgery

1. You will be fully assessed to check you are physically well enough for surgery.

This starts with the consultation with your surgeon in clinic, you will then attend a pre-assessment clinic where you are assessed by a specialist nurse and sometimes an anaesthetist if you have other medical problems. You may require some additional blood tests and investigations before your surgery. You will have a chance to ask questions about your anaesthetic and what happens before and after surgery.

2. A spinal or general anaesthetic are used so you do not feel the surgery.

For the majority of patients a general anaesthetic is used for the surgery. You will have a chance to discuss the anaesthetic before the surgery.

3. The replacement ligament or graft is taken from your hamstring tendons or your knee cap (patella) tendon.

The surgeon and their team will meticulously prepare the knee prior to surgery and apply sterile drapes over the knee. A torniquet is used in some cases. A careful incision is made in the skin and the graft site is exposed. The new graft is taken most often from the same leg and then shaped and sutured into a new ACL. A keyhole camera is inserted into the knee through 5mm cuts and the knee is cleared of any debris from the injury. At this stage if there is a meniscus (shock absorber of the knee) injury it will be repaired or partially removed through the keyholes.

4. The new ligament is tunnelled through the knee with keyhole surgery and secured into the tibia and femur. The knee is checked thoroughly for movement and stability.

Once the knee is prepared a hole is made in the femur and tibia to match the size of your new ligament. The new ligament is inserted into these holes and held in place by sutures or screws which are specially designed. The surgeon very carefully assesses the movement and stability of the new knee ligament to check that it will function well for you. Once the ligament is secured in place everything is cleaned and the skin is closed. Local anaesthetic is inserted in the deep tissues to give you good pain relief on the ward.

5. You return to the ward and are helped on to your feet by the physios and discharged the same day as surgery.

You will spend some time in recovery after the operation. As soon as you are well enough you will be transferred to the ward. On the ward you will be seen by physios and nurses and as soon as possible you are encouraged to walk. You may have a check xray on the day of the surgery or the day after to confirm the position of the screws and tunnels and will return home the same day when it is safe for you to do so.