Orthopaedics
The Anterior Cruciate Ligament (ACL) is one of the ligaments which sits deep inside the knee. The ACL helps to keep the knee stable. This ligament can be torn or ‘ruptured’ by a fall or sports injury. Your knee may then give way or it may feel like it is giving way. It may stop you doing your normal activities or sports.
An operation can rebuild (reconstruct) the torn ligament. This involves removing what remains of the torn ligament and replacing it with a tendon from another area of the leg such as the hamstring or patellar tendon.
Guidance for patients
After your procedure you will need to use crutches for a few weeks. This will make it difficult to do some daily tasks.
Ahead of your surgery it may be helpful to plan to have some help from family or friends during this time. You could also stock up on food that’s easy to prepare, such as tinned foods and staples like rice and pasta. You could also prepare meals and put them in the freezer.
Exercise
We would recommend undertaking some exercises to help prepare for your surgery. This will help you to improve your outcome after surgery by strengthening the muscles you will be using and working during your recovery.
After an ACL tear the knee will usually be swollen, painful, weak and have limited movement. All inflamed joints benefit from RICE: rest, ice, compression and elevation. Apply an ice pack (wrapped in a towel to protect your skin), for 20 minutes every 2 hours until your swelling has reduced. Resting with your leg elevated so that gravity can help to reduce the swelling.
As the pain and swelling decreases, gentle exercise and stretching will encourage a return to normal movement. It is very important to regain full range of motion, particularly full extension (straightening) prior to ACL reconstruction surgery.
Here are some exercises you can do at home:
Squats
- Stand with your legs shoulder width apart
- Drop down into a squat position, pushing your hips back and keeping upright
- Ensure your knees do not go over your toes
- Control the movement back to the start position
- Repeat 10 times x 3 sets
Step lifts
- Step your affected leg onto a step
- Ensure you engage your thigh muscles as you straighten your knee to push yourself up onto the step
- Bring your unaffected leg onto the step
- Step off with your unaffected leg first using your affected leg to lower you down
- Repeat 10 times x 3 sets
Forward lunge
- Stand up straight with your hands on your hips
- Take a large step forward with your affected leg
- Bend your knees, lowing your hips down between both feet until your knees are bent to 90 degrees
- Make sure your front knee is directly above your ankle and pointing forwards
Single Leg Bridge
- Lie on your back with your legs bent and feet flat on the floor
- Keep affected leg on the floor and lift unaffected leg off the floor
- Engage your core, and then start to lift your hips up into a bridge carefully starting at your tailbone, driving the movement with your buttocks
- Carefully lower your back from the top of your spine down to your tailbone
- Repeat this 10 times x 3 sets
Single leg squat
- Stand on affected leg only with unaffected leg bent behind you
- Drop down by bending your affected leg, pushing your hips back and keeping upright
- Ensure hips stay level
- Ensure hip, knee and ankle on affected side stay in line
- Control the movement back to the start position
- Repeat 10 times x 3 sets
Lifestyle changes
We would encourage anyone waiting for surgery to lose some weight if necessary and to stop smoking. Both these measures are known to lower risk of complications following surgery.
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You can download a free NHS weight loss planning app to help you start healthier eating habits, be more active and start losing weight.
With help, you’re much more likely to quit smoking than if you use willpower alone. Visit Make Smoking History to get free access to the latest quitting aids, one-to-one advice and support in your local area
Mental health support
It’s important during this time to take care of your mind as well as your body. You might be feeling down, worried or anxious while you wait for your surgery.
Here you will find some general information on mental health issues and some top tips to improve your mental wellbeing.
There are also Apps available to help support your health, mental health and wellbeing:
You can find tested and approved mental health apps here.
Pain management
You can take pain relief such as Paracetamol, Anti-inflammatory creams, Codeine, Non-steroidal anti- inflammatory drugs. If you need any advice, your local pharmacy will be able to help.
Pain management
You can take pain relief such as Paracetamol, Anti-inflammatory creams, Codeine, Non-steroidal anti- inflammatory drugs. If you need any advice, your local pharmacy will be able to help.
There are several resources to help you manage your pain:
- 10 ways to ease pain
- The Chartered Institute of Physiotherapy has produced helpful guidance for managing pain and improving your quality of life
What should I do if my health is deteriorating?
This information is designed to help you manage your symptoms and stay in the best possible health while you wait. It is however possible that some of your symptoms may get worse while you are waiting for your surgery. There are some things to look out for that would indicate you should seek medical help:
- If your pain gets worse to the point that it is unmanageable with the pain relief suggested by the pharmacist or doctor and you are struggling to cope with it
- If your mobility gets worse to the point you are off your feet or unable to work
- If your knee suddenly deteriorates
If you experience any of these issues, we recommend getting in touch with your hospital team. The number and email should be on your last hospital appointment letter.
Alternatively, you can contact your GP practice. Whilst your GP does not have access to the hospital waiting list to get you seen sooner, if your condition is getting worse, they can assess you, give advice and can contact the hospital on your behalf if necessary.
If your condition gets worse but you already have your date for surgery, we recommend getting in touch with your hospital team. The number and email for this should be on the hospital appointment letter.
Links to more information
- NHS England advice on managing knee pain
- Versus Arthritis advice on managing knee pain
- NHS England information on knee ligament surgery
Patient experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.
T: 01642 835964
E: [email protected]