ACL Reconstruction Surgeon in Hertfordshire, Luton, Hatfield

Information about COVID-19 (Coronavirus)

On 11 March 2020 the World Health Organization confirmed COVID-19 (coronavirus) has now spread all over the world (this means it is a ‘pandemic’). Hospitals have very robust infection control procedures, however, it is impossible to make sure you don’t catch coronavirus either before you come into the hospital or once you are there. You will need to think carefully about the risks associated with the procedure, the risk of catching coronavirus while you are in hospital, and of not going ahead with the procedure at all. Your healthcare team can help you understand the balance of these risks. If you catch the coronavirus, this could affect your recovery and might increase your risk of pneumonia and even death. Talk to your healthcare team about the balance of risk between waiting until the pandemic is over (this could be many months) and going ahead with your procedure.

Please visit the World Health Organization website: www.who.int for up-to-date information.

Information about your procedure

Following the Covid-19 (coronavirus) pandemic, some operations have been delayed. As soon as the hospital confirms that it is safe, you will be offered a date. Your healthcare team can talk to you about the risks of having your procedure if you have coronavirus. It is then up to you to decide whether to go ahead or not. The benefits of the procedure, the alternatives and any complications that may happen are explained in this document. If you would rather delay or not have the procedure until you feel happy to go ahead, or if you want to cancel, tell your healthcare team.

If you decide to go ahead, you may need to self-isolate for a period of time beforehand (your healthcare team will confirm how long this will be). If you are not able to self-isolate, tell your healthcare team as soon as possible. You may need a coronavirus test a few days before the procedure. If your test is positive (meaning you have coronavirus), the procedure will be postponed until you have recovered.

Coronavirus spreads easily from person to person. The most common way that people catch it is by touching their face after they have touched anyone or anything that has the virus on it. Wash your hands with alcoholic gel or soap and water when you enter the hospital, at regular intervals after that, and when you move from one part of the hospital to another.

Even if you have had the first or both doses of a Covid vaccine, you will still need to practise social distancing, hand washing and wear a face covering when required.

If your healthcare team need to be close to you, they will wear personal protective equipment (PPE). If you can’t hear what they are saying because of their PPE, ask them to repeat it until you can. Chairs and beds will be spaced apart. You may not be allowed visitors, or your visiting may be restricted.

Your surgery is important and the hospital and health professionals looking after you are well equipped to perform it in a safe and clean environment. Guidance about coronavirus may change quickly ─ your healthcare team will have the most up-to-date information.

What is the anterior cruciate ligament?

The anterior cruciate ligament (ACL) is one of the important ligaments that stabilise your knee. If you have torn (ruptured) this ligament, your knee can collapse or ‘give way’ when making twisting or turning movements. This may interfere with sports or even everyday activities.

Your surgeon has recommended an ACL reconstruction to replace the torn ligament. However, it is your decision to go ahead with the operation or not. This document will give you information about the benefits and risks to help you to make an informed decision.

If you have any questions that this document does not answer, it is important that you ask your surgeon or the healthcare team. Once all your questions have been answered and you feel ready to go ahead with the procedure, you will be asked to sign the informed consent form. This is the final step in the decision-making process. However, you can still change your mind at any point before the procedure.

How does an ACL rupture happen?

A torn ACL

An ACL rupture happens as a result of a twisting injury to your knee. The common causes are contact sports and skiing injuries. At first, your knee fills with blood and can be swollen and painful but this settles with time. You can injure other parts of your knee at the same time such as tearing a cartilage (meniscus) or damaging the joint surface.

Some people with an ACL rupture get back good function in their knee with the help of exercises and physiotherapy. If your knee continues to give way, your surgeon may recommend ACL reconstruction.

What are the benefits of surgery?

Your knee should not give way any more. This will allow you to be more active and you may be able to return to some of or all your sporting activities.

Are there any alternatives to surgery?

The physiotherapist can give you exercises to strengthen and improve the co-ordination of the quadriceps and hamstring muscles in your thigh. This can often prevent your knee from giving way during everyday activities.

Wearing a knee brace can sometimes help if your knee only gives way while you are playing sports. However, a brace is often too bulky and awkward to wear all the time.

What will happen if I decide not to have the operation?

Unless you are a high-level athlete, there is a 4 out of 5 chance that your knee will recover to near normal without surgery. High-level athletes do not usually do well without surgery.

If your knee continues to give way, you can get a torn cartilage (risk: 1 in 30). You will usually need another operation to remove or repair the torn piece of cartilage.

What does the operation involve?

A torn ACL

The healthcare team will carry out a number of checks to make sure you have the operation you came in for and on the correct side. You can help by confirming to your surgeon and the healthcare team your name and the operation you are having.

Various anaesthetic techniques are possible. Your anaesthetist will discuss the options with you.

You may also have injections of local anaesthetic to help with the pain after the operation.

You may be given antibiotics during the operation to reduce the risk of infection. The operation usually takes an hour to 90 minutes.

Your surgeon will make one or more cuts around your knee. Most surgeons perform the operation by an arthroscopy (keyhole surgery), using a camera to see inside your knee.

Your surgeon will replace the ACL with a piece of suitable tissue (a graft) from another area of your body. They will usually use one of your hamstring tendons. There are other options, such as donor or artificial grafts, and your surgeon can discuss these with you.

The top and bottom ends of the replacement ligament are fixed with special screws or anchors into holes drilled in the bone.

Your surgeon will close your skin with stitches or clips.

What should I do about my medication?

Make sure your healthcare team knows about all the medication you take and follow their advice. This includes all blood-thinning medication as well as herbal and complementary remedies, dietary supplements, and medication you can buy over the counter.

What can I do to help make the operation a success?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

You can reduce your risk of infection in a surgical wound.

• In the week before the operation, do not shave or wax the area where a cut is likely to be
• Try to have a bath or shower either the day before or on the day of the
• Keep warm around the time of the Let the healthcare team know if you feel cold.
• If you are diabetic, keep your blood sugar levels under control around the time of your

If you have not had the coronavirus (Covid-19) vaccine yet, ask your healthcare team if this can be done before your operation. This will reduce your risk of serious illness related to Covid-19 while you recover.

What complications can happen?

The healthcare team will try to reduce the risk of complications.

Any numbers which relate to risk are from studies of people who have had this operation. Your doctor may be able to tell you if the risk of a complication is higher or lower for you.

Some complications can be serious and can even cause death.

You should ask your doctor if there is anything you do not understand.

Your anaesthetist will be able to discuss with you the possible complications of having an anaesthetic.

General complications of any operation

• Bleeding during or after the operation. If you get a lot of blood in your knee (a haemarthrosis), it will be swollen and painful (risk: 1 in 25). You may need another operation to wash the blood
• Infection of the surgical site (wound) (risk: 1 in 135). It is usually safe to shower after 2 days but you should check with the healthcare Keep your wound dry and covered. Let the healthcare team know if you get a high temperature, notice pus in your wound, or if your wound becomes red, sore or painful. An infection usually settles with antibiotics but you may need special dressings and your wound may take some time to heal. In some cases another operation might be needed. Do not take antibiotics unless you are told you need them.
• Allergic reaction to the equipment, materials or The healthcare team is trained to detect and treat any reactions that might happen. Let your doctor know if you have any allergies or if you have reacted to any medication or tests in the past.

• Blood clot in your leg (deep-vein thrombosis – DVT) (risk: 1 in 350). This can cause pain, swelling or redness in your leg, or the veins near the surface of your leg to appear larger than normal. The healthcare team will assess your risk. They will encourage you to get out of bed soon after the operation and may give you injections, medication, or inflatable boots or special stockings to Let the healthcare team know straight away if you think you might have a DVT.
• Blood clot in your lung (pulmonary embolus), if a blood clot moves through your bloodstream to your lungs (risk: 1 in 550). Let the healthcare team know straight away if you become short of breath, feel pain in your chest or upper back, or if you cough up blood. If you are at home, call an ambulance or go immediately to your nearest Emergency
• Difficulty passing urine. You may need a catheter (tube) in your bladder for 1 to 2
• Chest If you have the operation within 6 weeks of catching Covid-19, your risk of a chest infection is increased (see the ‘Covid-19’ section for more information).

Specific complications of this operation

• Break of your kneecap (patella) during or after the operation (risk: 1 in 100). This can only happen if your surgeon uses a patellar tendon graft. The bone where the graft is taken from becomes If your kneecap breaks, you may need another operation.
• Damage to nerves around your knee, leading to weakness, numbness or pain in your leg or foot (risk: 1 in 300). This usually gets better but may be
• Infection in your knee (risk: 1 in 400). You will usually need another operation to wash out your knee and a long course of Infection can cause permanent damage.
• Discomfort in the front of your knee, around the scar and the screw that holds the lower end of the graft (risk: 1 in 3). This is not usually too troublesome but it can make it difficult for you to
• Loss of knee movement, preventing full bending (risk: 1 in 50) or straightening (risk: 1 in 7). This usually improves with physiotherapy but you may need another

• Your knee keeps giving way, if the ligament graft fails caused by it gradually stretching or a further sports injury (risk: 1 in 10).
• Severe pain, stiffness and loss of use of your knee (complex regional pain syndrome). The cause is not known. You may need further treatment including painkillers and Your knee can take months or years to improve. Sometimes there is permanent pain and stiffness.

Covid-19

A recent Covid-19 infection increases your risk of lung complications or death if you have an operation under general anaesthetic. This risk reduces the longer it is since the infection. After 7 weeks the risk is no higher than someone who has not had Covid-19. However, if you still have symptoms the risk remains high. The risk also depends on your age, overall health and the type of surgery you are having.

You must follow instructions to self-isolate and take a Covid-19 test before your operation. If you have had Covid-19 up to 7 weeks before the operation you should discuss the risks and benefits of delaying it with your surgeon.

Consequences of this procedure

• The healthcare team will give you medication to control the pain and it is important that you take it as you are told so you can move about as advised.
• Unsightly scarring of your

How soon will I recover?

In hospital

After the operation you will be transferred to the recovery area and then to the ward. You will usually have an x-ray to check the position of the ligament graft. At first your knee will be swollen and it takes hard work to get it to bend.

Keep your wound dry for 4 to 5 days, and use a waterproof dressing when you have a bath or shower. The healthcare team will tell you if you need to have any stitches or clips removed, or dressings changed.

You should be able to go home the same day or the day after. However, your doctor may recommend that you stay a little longer.

If you do go home the same day, a responsible adult should take you home in a car or taxi and stay with you for at least 24 hours. Be near a telephone in case of an emergency.

If you are worried about anything, in hospital or at home, contact the healthcare team. They should be able to reassure you or identify and treat any complications.

Returning to normal activities

Do not drive, operate machinery or do any potentially dangerous activities (this includes cooking) for at least 24 hours and not until you have fully recovered feeling, movement and

co-ordination. If you had a general anaesthetic or sedation, you should also not sign legal documents or drink alcohol for at least 24 hours.

To reduce the risk of a blood clot, make sure you carefully follow the instructions of the healthcare team if you have been given medication or need to wear special stockings.

Your surgeon may want you to wear a knee brace for a few weeks. Once your knee is settling down you will need to start intensive physiotherapy treatment.

The healthcare team will tell you when you can return to normal activities. It is important to follow the instructions they give you during your rehabilitation. In particular, do not return to sports until you are told that it is safe to do so.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Do not drive until you can control your vehicle, including in an emergency, and always check your insurance policy and with the healthcare team.

Ask your healthcare team if you need to do a Covid-19 test when you get home.

The future

Most people make a good recovery after an ACL reconstruction but this takes hard work.

It is unlikely that your knee will ever be as good as it was before the original injury.

Mild stiffness is common within a year or two but is not usually troublesome.

Summary

If your knee continually gives way after an ACL rupture, reconstruction offers the chance of improving the stability of your knee in everyday life and in sporting activities. You may be able to return to a level of sport that otherwise would not be possible.

Surgery is usually safe and effective but complications can happen. You need to know about them to help you to make an informed decision about surgery. Knowing about them will also help to detect and treat any problems early.

ACL Reconstruction

if you would like to have additional information on the treatmentof ACL injury or would like to learn more about ACL reconstruction, please contact Mr Tarique Parwez, serving the communities of Hertfordshire, Luton, Hatfield.

Other Knee Procedures