ACL Reconstruction Surgery: Procedure, Costs, and Recovery

What is ACL reconstruction surgery?

An ACL reconstruction surgery is a procedure to reconstruct a damaged anterior cruciate ligament in the knee. This is achieved by replacing the damaged ligament with similar tissue (graft) from another part of the body or from a donor.

This surgery aims to restore stability and functionality of the knee joint while also preventing the development of osteoarthritis, chronic instability, and further joint damage. This knee surgery allows you to resume daily activities and return to exercise just as you did before.

When should I consider ACL reconstruction surgery?

ACL reconstruction surgery is recommended if there's a completely torn ligament and significant knee instability. Here are some conditions that indicate the need for a surgical procedure, including:

• Knee instability

  • Your knee feels unstable or buckles during routine activities or exercises.

• Other knee injuries

  • The ACL injury occurs in conjunction with other knee injuries, such as a torn meniscus, ligament injuries (such as MCL or LCL damage), or cartilage damage.

• Ineffectiveness of non-surgical treatment

  • If non-surgical treatment, such as physical therapy or bracing, hasn't improve your condition.

• Recurring ACL injuries

  • If you have experienced repeated ACL injuries, despite treatment.

• Physical demands of work

  • If your job involves rigorous physical activity and places excessive pressure on your knees

• Young age

  • If you are in your teens to thirties and have already injured your ACL, you are at a greater risk of experiencing future knee instability.

If you are experiencing the aforementioned symptoms and need a thorough evaluation, request an appointment at Thomson Medical. Our orthopaedic specialists are dedicated to providing you with an accurate diagnosis and a personalised treatment plan, including surgery.

Pre-surgery preparation

An ACL reconstruction surgery aims to relieve pain, restore the natural range of movement, and rebuild strength in the knee. This knee surgery is conducted by an orthopaedic surgeon, who replaces the torn ligament with a tissue graft that replicates the function of a natural ACL. Before undergoing surgery, an orthopaedic surgeon will conduct an assessment to determine your suitability for surgery and discuss any concerns you might have. Here’s a breakdown of what to expect:

Preoperative preparation

• During this stage, your doctor will examine your medical history and assess your conditions.

• The doctor may enquire about the medications you're currently taking and may give a recommendation to stop consuming certain medicines that make it harder for your blood to clot, such as aspirin, ibuprofen, or naproxen.

• They will also verify that you do not have other health conditions such as flu, fever, herpes breakout, or high blood pressure (hypertension).

• Your doctor will ask if you have dentures, dental caps, or plates, as a breathing tube will be inserted through your throat during surgery. Any loose dental work could pose a risk during this process.

Physical examination

• Your doctor will conduct a thorough examination of the knee to assess the severity of the torn ACL and evaluate other knee ligaments for any looseness that may need to be treated.

• To get a better diagnosis, your doctor may perform imaging tests, such as X-rays, to check for potential fractures. 

• Additionally, magnetic resonance imaging (MRI) scans may be performed to assess the ACL and rule out other knee injury issues, such as a meniscus tear.

Graft discussion

The doctor may also discuss with you the type of tissue (graft) that will be used to replace the ACL.

• Autograft

  • This graft usually comes from the quadriceps tendon and the hamstring tendons. These grafts tend to integrate quickly into the body as they come from your body, with no risk of disease transmission or tissue rejection.

  • Additionally, this graft is also suitable for younger and more active patients due to their strength and lower risk of graft failure.

• Allograft

  • Other options are an allograft, which comes from a donor who donated their body to medical causes after their passing. Don't worry, these grafts are tested for any diseases and sterilised before being used.

  • This graft offers benefits such as a smaller incision, reduced recovery time, shorter operation times, and less postoperative pain. Since there's no additional surgical site on your body to take the graft tissue.

  • However, allograft tissue is not advised for young patients due to the significantly higher risk of reinjury and graft failure.

Physiotherapy

• The surgeon might also delay the surgery between 3 and 6 weeks after the injury and advise you to take physical therapy before proceeding with the surgery.

• Physiotherapy aims to reduce inflammation in the injured area, restore full range of movement, and strengthen the muscles at the front of your thigh (quadriceps) and back of your thigh (hamstrings).

• If the surgery is performed when you still have a limited knee range of movement, a scarring response called arthrofibrosis might develop. This scarring can cause stiffness to the knee joint, a more difficult recovery, and trouble regaining motion after surgery.

Anaesthesia

• Before the surgery begins, your anaesthesiologist will discuss your anaesthesia options with you. 

• These options include general anaesthesia, which puts you into a deep sleep, or spinal anaesthesia, where it's injected into your spine so you remain awake while your lower body is numbed.

Surgical steps

On the day of surgery, patients will be administered anaesthesia, and the procedure will begin. The surgery usually lasts between one and two hours.

1) Knee examination

• Once the anaesthesia takes effect, the surgeon will make small incisions around the knee joint. Through this cut, they will then examine the ACL and look for other damage in the knee, using a small camera called an arthroscope.

2) Damaged ACL removal

• Following the examination process, the surgeon then removes the damaged ACL along with a small amount of bone from the ends of the thigh bone (femur) and shin bone (tibia).

• In addition to the ACL reconstruction, additional procedures may be performed to the meniscus, cartilage, or other ligament if an injury is present.

3) Grafting

• The next process is replacing your damaged ACL with a graft. The type of graft used will depend on your condition and the discussion between you and your doctor prior to the surgery.

• The graft tissue will be cut to the correct size and positioned to the prepared site, with a plastic spacer inserted between the thigh bone (femur) and shin bone (tibia) to replicate the function of the ACL cartilage.

• The graft is then secured by “wedging” a screw between the side of the bone or by other techniques, such as staples, sutures, buttons.

4) Closing

• After the procedure and ensuring that the graft tissue has been secured, your surgeon will test that it's strong enough to hold your knee together.

• They'll also check that your knee has the full range of motion and that the graft keeps your knee stable when it's bent or moved.

• Once everything is in order, the surgeon will stitch or staple the incision, and then dressing and bandage are applied.

Immediate postoperative care

After the procedure has concluded, you will be moved to a recovery room and closely monitored as you wake up from the anaesthesia. Usually you can go home on the same day of surgery. To help support your leg, you might be instructed to use a knee brace or crutches for the first 1 to 6 weeks.

Recovery process

After the surgery procedure, physiotherapy is an important aspect of rehabilitation. This therapy helps regain strength, restore range of motion, and improve the stability of the knee. Your physiotherapist will provide tailored guidance and a structured rehabilitation program, which can last up to 4 or 6 months. Adhering to this program is important to ensure a successful recovery. Following your postoperative care, you can expect the following procedures below to help you make a complete recovery:

Immediate post-surgery (1-2 weeks)

• Rest, ice, and elevation treatment to reduce knee swelling and pain.

• Taking prescribed medicines to help manage pain.

• Use of crutches or a knee brace to help support the knee.

• Physical therapy begins within a few days after the surgery with gentle range of motion exercises.

Short-term recovery (6-12 weeks):

• Physical exercise improves flexibility, builds muscle strength, and restores knee function. With focus on strengthening the quadriceps, hamstrings, and calf muscles.

• As the pain subsides, you can gradually return to everyday activities within six weeks, although high-impact activities should still be avoided.

Long-term recovery (4-9 months):

• Customised strength training and functional exercises specific to your sport or activity level prior to the injury.

• Running, jumping, or pivoting exercises will be progressively incorporated into the rehabilitation program.

Full recovery

• It may take up to 9-12 months after surgery to fully recover and return to competitive sports that require quick changes in direction.

Costs of ACL reconstruction surgery

The cost of an ACL reconstruction surgery in Singapore may vary depending on the type of clinic (public or private) and the specific services included in the treatment. Here are the estimated costs of this procedure in Singapore:

• Public hospitals

  • Public hospitals are usually more affordable due to government subsidies, with fees approximately ranging from SGD $4,000 to SGD $6,000.

• Private clinics

  • Based on Ministry of Health guidelines, the approximate cost of ACL surgery in a private hospital can go up to SGD $30,000. Which covers the doctors’ fees, hospital fees, and anaesthetic cost.

Available payment options

• MediSave

• MediShield Life

• Health insurance coverage

However, there are several important things you should keep in mind:

• Actual costs may vary based on individual medical conditions.

• Additional charges may apply for complications or extended care.

• Pre-surgical consultations and follow-up visits may incur separate fees.

• Fees are subject to change.

The information provided above serves as a general guide only and should not be considered a quotation or guarantee of costs. Actual fees may vary based on individual medical circumstances, complexity of treatment, and specific medical requirements. All fees are subject to prevailing GST and may be revised without prior notice.

Potential post-surgery complications

Although ACL reconstruction surgery is generally safe, there is still a risk of potential complications associated with this procedure. Your orthopaedic surgeon will mitigate these complications by reviewing the risks with you beforehand and taking proactive measures. Here are potential complications that might happen post-surgery, including:

• Infection at the surgery site

• Blood clots

• Knee weakness and stiffness

• Graft failure, which is a re-tear of the ACL graft

• Damage to the surrounding nerve or blood vessel

• Chronic knee pain and instability

FAQ

Is ACL reconstruction a major surgery?

Even though ACL reconstruction surgery only took 1 to 2 hours and was performed arthroscopically through small incisions. This procedure is still considered a major surgery due to its complexity and potential risks, which involves replacing the damaged ligament with a tissue graft.

What is the recovery time for ACL reconstruction surgery?

Recovery time can vary between individuals, but everyday activities can return within 1 to 3 months after surgery. But a full recovery for competitive sports that require quick changes in direction may take up to 1 year.

Will my ACL heal on its own without surgery?

A completely torn ACL does not heal on its own, as ligaments lack the blood supply needed for natural repair. Without surgery, the knee may remain unstable, which can lead to further damage over time.

How long does it take to walk after ACL surgery?

Most patients can begin walking with crutches within a few days after surgery. Full weight bearing without crutches usually starts within 2–3 weeks, depending on how quickly swelling and pain subside.

Will I ever be 100% after ACL surgery?

With proper rehabilitation, most patients regain strength and function similar to pre-injury levels. However, it depends on the individual, the severity of the injury, and the success of rehab. Some athletes return to their previous performance, while others may need to adjust their activities.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist at Thomson Medical. Request an appointment with Thomson Medical today.