ACL reconstruction – keyhole surgery

Anterior cruciate ligament (ACL) reconstructions are performed at SWLEOC by leading UK surgeons.


A knee anterior cruciate ligament (ACL) reconstruction is a surgical procedure to replace the torn ACL in the knee joint.

It aims to improve patients quality of life and function who suffer from a ligament rupture (usually from playing sport) once physiotherapy and rehab have failed to give you the function you need.

Why would I need an ACL reconstruction?

Patients rupture their anterior cruciate ligament during a twisting motion usually from sport or an accident


The initial symptoms include knee swelling and pain which prevents you from continuing the activity you were performing

Not everyone who suffers an ACL rupture requires surgery. Some people including professional athletes can get enough stability in the knee from extensive rehab and physiotherapy


If you have been unable to return to sport or you lose confidence in your knee joint and feel like it will give way when you turn it may be time to consider surgery to have the ligament reconstructed

What happens during the procedure?

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.

What happens during the procedure?

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.

What happens during the procedure?

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.

What happens during the procedure?

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.

What happens during the procedure?

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.


All surgical procedures have risks associated with them, some of the specific ones are listed below. You will have a detailed discussion with your surgeon about:

  • Bleeding and blood clots which can be life threatening but are rare and we have measures in place to keep you safe
  • Infection which in SWLEOC is lower than the national average.
  • Knee stiffness after the procedure is common and physiotherapy is required. It takes 9-12 months for return to sport from an ACL reconstruction
  • Need for further surgery or to have the surgery done again if the ligament fails or becomes infected

Recovery time

0-3 Days
Walk on day 0 with crutches but fully weight bearing. Discharge from hospital the same day

2 weeks

2 weeks increasing range of motion and off crutches unless had a meniscus tear

6 weeks

Walking without crutches into clinic for review at 6 weeks with a full range of motion

Information videos