ACL Surgery In Singapore

A complete medical evaluation, including imaging studies such as MRI scans, provides detailed images of the knee and assesses the extent of ligament damage. Blood tests are also conducted to ensure the patient is fit for the procedure. This evaluation enables the surgeon to create a detailed, personalised surgical plan.

Patients should provide their surgeon with a complete list of medications, supplements, and allergies. Certain medications, particularly blood thinners, may need to be adjusted or temporarily discontinued several days before surgery to minimise bleeding risks and other complications.

Patients are typically instructed to fast for several hours before the procedure, starting at midnight the night before surgery. Fasting ensures an empty stomach, reducing the risk of complications during anaesthesia, such as aspiration (when stomach contents enter the lungs).

The patient is administered general or spinal anaesthesia. General anaesthesia keeps the patient fully asleep, while spinal anaesthesia numbs the lower body, allowing the patient to remain awake while pain-free. Sedation may also be used to help the patient relax.

ACL reconstruction is commonly performed using an arthroscopic technique. Small incisions are made around the knee to allow the surgeon to view the joint using a camera and specialised instruments.

During the procedure, the torn ACL is removed and the knee is assessed for associated injuries, such as meniscus or cartilage damage. The selected graft is then prepared and positioned to reconstruct the ligament and help restore knee stability.

The surgeon drills small tunnels into the thighbone and shinbone to anchor the graft. The new ligament graft is placed through these tunnels and secured with screws or other fixation devices to hold it in place.

Once the graft is in place, the surgeon puts the knee through a series of motions to ensure that the new ligament is stable and properly aligned. Adjustments are made as needed to achieve optimal stability and function.

After confirming proper placement and stability, the incision is closed using sutures or staples. A sterile bandage is applied to protect the surgical site, and in some cases, a temporary drainage tube may be placed to remove excess fluid from the area.

During ACL reconstruction, the torn ligament is replaced with a graft to help restore knee stability. Common graft options include the hamstring tendon, patellar tendon, quadriceps tendon, or donor tissue.

A hamstring tendon graft is taken from the tendons at the back of the thigh. A patellar tendon graft, also known as a bone-patellar tendon-bone graft, is taken from the front of the knee, together with small bone blocks from the kneecap and shin bone.

The choice of graft depends on factors such as the patient’s age, activity level, sport participation, knee condition, associated injuries, and rehabilitation goals. Dr Dennis Ng will discuss the suitable graft option during consultation based on the patient’s injury profile and treatment needs.

Post-surgery discomfort is normal, especially in the first few days. Pain can be managed through prescribed medications, which may include stronger painkillers initially. As recovery progresses, over-the-counter pain relievers such as ibuprofen can be used. Ice therapy and keeping the leg elevated can also help reduce pain and swelling.

The surgical incision must be kept clean and dry to avoid infection. Any signs of infection, such as increased redness, swelling, or unusual discharge, should be reported immediately.

Patients should avoid strenuous activities, such as heavy lifting and twisting movements, for the first few weeks. Light activities, such as walking with crutches, are encouraged to promote circulation and help prevent complications like blood clots. Gentle range-of-motion exercises may be introduced to prevent stiffness and maintain flexibility.

Physiotherapy is necessary after ACL reconstruction, starting with gentle exercises to restore range of motion and gradually progressing to strengthening exercises. A physiotherapist guides each phase of recovery, ensuring the knee is not overexerted in the early stages.

Around weeks 4 to 6, moderate activities may resume, but high-impact exercises like running should still be avoided. A full return to intense physical activities, including sports, usually occurs between 6 and 12 months, pending clearance from your specialist.

Return to sport after ACL reconstruction varies depending on the patient’s injury severity, graft type, associated meniscus or cartilage treatment, rehabilitation progress, knee strength, and movement control.

Sports-specific activities such as running, jumping, pivoting, and direction changes are usually introduced gradually during the later stages of rehabilitation. Progression should be guided by clinical assessment, physiotherapy milestones, and the treating specialist’s advice.

Return to sport should not be based on time alone. It should take into account knee stability, strength testing, movement quality, confidence, and the physical demands of the patient’s chosen sport.