ACL (Anterior Cruciate Reconstruction)
How do you know when an ACL reconstruction is necessary?
If the ACL (anterior cruciate ligament) is torn, this may occur after sport or after knee trauma. The
patient experiences giving way and normal activities are not possible due to instability of the joint.
Patients who are involved in pivoting or twisting sports such as basketball, tennis, soccer, rugby or other
racquet sports and ski-ing, will be unable to partake without the knee giving way. Patients who have
active manual activities such as outdoor jobs in building or construction or are involved in the services or
police and fire services will not be able to resume their employment without stability of the joint.
Under these considerations surgery is necessary to restore stability and function as well as safety to the
Are there significant long term effects of ACL rupture?
The immediate problem with anterior cruciate ligament rupture is the giving way or instability of the joint. However long term studies indicate that patients with an absent ACL or ACL damage will suffer abnormal movements of the knee during every day life. It is known that these patients because of the abnormal movements, will suffer significant damages to the two cartilages or washer like structures within the knee. Damage to the washer like structures will increase the rate of wear in the joint and
therefore athletes who suffer an anterior cruciate ligament injury are well known to develop osteo-arthritis or wear and tear arthritis in the knee much earlier than the normal population. Anterior cruciate ligament reconstruction is often perceived as a method of stabilising the joint not just for the short term function of the knee but in order to try and prevent long term damage in early osteo-arthritic change in the joint.
Is there any other surgery required following ACL reconstruction such as to remove the screws?
It is very rare to remove the screws after anterior cruciate ligament reconstruction or indeed any of the
fixation devices which are made of titanium as they are designed to last in the bone for a life time.
Occasionally if screws or fixation devices are troublesome they may be removed at a short surgical
procedure as a day case surgery.
How long does an ACL reconstruction last?
The anterior cruciate ligament reconstruction should last the rest of your life. There is an early period of
twelve weeks in which the graft recovers its blood supply and becomes stronger, thereafter increasing its
strength from twelve weeks until eight months post surgery when it will be strong enough to undertake
contact sports with the appropriate training. The graft will not be rejected as it is your own tissue, but
care and attention should be taken to the appropriate rehabilitation protocols for ACL reconstruction (see
ACL reconstruction on the website).
Is there numbness around the front of the knee following surgery?
With all surgical incisions there is numbness and some discomfort around the surgical incision site in the
first few months. Small fibres of nerves which are cut within the skin incision will make the area around
the scar numb for a few months until those structures grow back and sensation is restored to the joint.
Are there different ways in which the anterior cruciate ligament may be reconstructed?
There are several different methods by which different donor material may be used to reconstitute the
anterior cruciate ligament. Three common methods are –
1. Use of the hamstring tendons
2. Use of the patellar tendon
3. Use of human donated tissue (allograft)
Depending on the patient’s wishes regarding activity post surgery, the patient’s build and sex and nature
of the injury each graft is assessed on its suitability as an individual choice for that patient. There are pros
and cons to each type of anterior cruciate ligament reconstruction and Professor Barrett will be able to
advise you and perform each of these surgeries depending on your choice and the indications for
What if I overdo things in the rehab period?
It is advisable not to go beyond the physiotherapist’s advice and do extra activities in the rehabilitation. If
the knee joint is over stressed it becomes painful and swollen. This should be an indication to reduce all
activities immediately other than that of simple day-to-day movements. Anti-inflammatories may be
taken and the joint should be rested and iced to restore the swelling to normal.
Once the joint is reduced to a normal size and pain and discomfort has stopped, normal activities at a
much lower level may be resumed.
Total Knee Replacement
How long should a total knee replacement last?
Normally with normal rates of activity a knee replacement may be expected to last between twelve and
fifteen years. However activity levels between patients along with weight, activity status, age and type of
activity vary considerably and these will all influence the longevity of the implant. Commonly the knee
joint may fail through loosening between the bone and the metal insert or more commonly, wear of the
plastic bearing that separates the two metal parts of the knee (see illustrations in total knee resurfacing
part of the website). Several of the knee resurfacings employed by Professor Barrett have the advanced
facility to have the plastic bearing exchanged to increase the longevity of the implant.
What activities may I undertake following total knee resurfacing?
Professor Barrett uses implants that are modelled to accept the highest form of activities for patients
undergoing knee surgery. The knee resurfacings used by Professor Barrett will enable kneeling, dancing,
swimming, doubles tennis, ski-ing and other racquet sports. Many patients find kneeling a little
uncomfortable related to the scar over the front of the knee but no significant damage will be done by the
What about sex following knee joint surgery?
Patients may resume sexual activities when they feel the discomfort of the knee settling down and feel
able to indulge in such an activity. Clearly care should be taken over the wound related to the knee and
patients may choose to modify their positions to reduce the load on the joint in the healing phase. In the
long term however no special precautions for the knee need to be taken.
Can I have another knee replacement?
Knee joints will eventually wear out as any mechanical structure. Knee joint replacement is performed on
those patients suffering wear and is commonly performed as an expert procedure by Professor Barrett.
The bearing between the two metal inserts may be replaced or indeed the whole joint may be re-operated
upon. It is accepted that sometimes the results from second time surgery are not as effective as first time
surgery and that following multiple replacements the artificial joint may be less effective, however there
is no limit to the number of times you may have joint revision surgery.
How soon can I return to normal activities after surgery?
On return from hospital following a four to five day stay, the patient will be able to walk and ascend and
Over the following subsequent six weeks the knee joint function will improve until the patient is walking
normally perhaps with a stick for support and able to ascend and descend stairs normally using a rail.
Increasingly the patient will be able to bend following six weeks and indulge in more normal activities
and by twelve weeks the patient will effectively have a normal range of movement. Muscle strengthening
however continues up to a year following surgery and many surgeons will indicate that full recovery has
not taken place until twelve months has elapsed since the knee joint surgery.
Will an implant set off a metal detector?
Most implants are made of a medical grade of stainless steel. This metal will set off metal detectors such
as those used at airports. Patients may wish for a covering letter provided by Professor Barrett in order to
show security personnel.
How common is knee resurfacing surgery?
Knee resurfacing surgery is major surgery although it is routine amongst surgeons who have expertise in
this procedure. Approximately 600,000 people worldwide undergo some form of knee resurfacing
procedure each year. Over 90% of those patients will achieve a very significant improvement of quality
of life and pain relief.
I am knock-kneed/bow legged. Can knee replacement surgery make my leg straight?
As part of the knee resurfacing surgery, Professor Barrett would wish to restore the normal alignment to
the joint to reduce the normal function of the limb and restore the ligaments and muscles to normal
function. He will endeavour to straighten your legs back to their normal alignment.