The anterior cruciate ligament (ACL) is one of the two cruciate ligaments found in the knee. ACL injury rarely occurs in isolation and tends to be accompanied by other damages such as meniscus injuries.  

Whilst there are many types of surgeries available for ACL reconstruction, arthroscopic ACL surgery is a treatment option favoured by many orthopaedic experts.  Arthroscopic ACL reconstruction surgery is also referred to as “keyhole surgery” and is a method which allows for diagnosis and treatment to be executed together.

There is a distinction between ACL repair and ACL reconstruction, the former addresses less severe grades of injury while the latter for more severe conditions. ACL reconstruction would commonly include replacing the torn ligament.

Some of the factors affecting the appropriateness of ACL reconstruction surgery include the following:

• When conservative treatments are ineffective. Studies have indicated that ACL reconstruction surgeries should be administered within 3-6 weeks after injury to reduce risk exacerbation of the condition. During this period assessments will be made and if injury worsens and does not improve with conservation treatments, ACL reconstruction surgery would be advised.
• When your orthopaedist deems an acute (within 8 days of when the injury is incurred) ACL reconstruction surgery is necessary. ACL reconstruction would also be administered when the injury sustained has exacerbated to a grade 3 injury where there is a complete tear or rupture. This decision is often made when patients present complete instability of the knee joint.
• When patients seek out urgent treatment for a speedy recovery; patients that are athletes tend to seek treatment with the quickest recovery rate.

Following the assessment, a graft selection is first made. Grafts are the tissues used to reconstruct PCL structures. Options for types of graft include autografts (harvested from one's own body), and allografts (obtained from a donor).

During the surgery, two or three small incisions are made at the knee and an arthroscope is inserted, allowing your surgeon to visually assess the condition of your knee through the camera. This phase of the procedure is also known as arthroscopic diagnosis.

Next, the preparation of grafts is conducted, the procedure will vary depending on the type of graft obtained. Following the preparation, bone tunnel placements will be made to create space for graft fixtures. On top of addressing PCL reconstruction, other injuries that may have occurred such as ACL or meniscus injuries will also be addressed during the surgery

The surgical site is then irrigated to prevent infections before it is closed either by suture or staples.  

• Minimally invasive
• Quicker discharge
• Minimal scarring
• Short recovery period

ACL reconstruction can be used to treat the following conditions:

• ACL injuries: such as sprains, ACL avulsion fracture, ACL deficiency.
• Multi-ligament knee injuries: also known as MLKI, it involves a combination of PCL injuries, MCL injuries, ACL injuries, and LCL injuries.  

ACL surgeries have a high success rate (80-90%). Success can be defined in this case, as complete recovery and regaining knee stability. Additionally, athletes too would be provided with the opportunity to return to their preinjury sports without deterred performance provided that dedicated rehabilitation measures such as physiotherapy are observed.

The recovery period varies depending on the grade of injury that is sustained. Depending on the individual, recovery could take anywhere between 6 to 9 months. Diets, habits, and dedication towards rehabilitation will play a role in the rate of recovery.

With positive post-surgical care and collaborative work with your orthopaedist, you can expect a satisfactory outcome.

Results will vary from person to person, depending on the severity of the issue and your overall health. Your orthopaedist can give you a better idea of what to expect based on your individual needs and circumstances.

Arthroscopic ACL surgery is a one-off treatment. However, treatment for ACL injury does not stop at the surgery.

To attain complete recovery, one will need to attend physiotherapy sessions and appropriately manage medications such as painkillers. The frequency of physiotherapy sessions will vary according to your personal goals such as the need to return to athletic endeavours.