ACL Surgery Singapore
MBBS (SINGAPORE) MMED (ORTHO) FRCS ED (ORTH)
Dr Bryan Tan is a fellowship-trained orthopaedic surgeon who manages knee conditions, including cases that may require ACL surgery. With over 20 years of clinical experience, he has been involved in the assessment and treatment of sports-related ACL injuries, as well as reconstructive procedures for patients with knee instability, and previously served as a consultant orthopaedic surgeon at the National University Hospital (NUH) in Singapore.
What Is ACL Surgery?
ACL surgery refers to a procedure that reconstructs the anterior cruciate ligament in the knee when it is torn and unable to provide adequate stability. The ACL plays a key role in controlling knee movement, particularly during activities that involve sudden stops, pivoting, or changes in direction. When this ligament is injured, the knee may feel unstable or give way during movement.
The procedure typically involves replacing the torn ligament with a graft, which may be taken from the patient’s own tissue or from a donor source. This graft is positioned to restore the function of the original ligament and support knee stability during movement.
- The torn ligament is removed and replaced with a tendon graft
- The graft is secured within the knee using fixation devices
- Small incisions are used to access the joint and guide the procedure
- The goal is to restore stability and support controlled knee movement
Recovery following surgery involves a structured rehabilitation process. Physiotherapy plays a key role in helping the knee regain strength, range of motion, and function over time.
Symptoms Of ACL Tear
The ACL provides strong support of the knee and helps to limit rotation and forward movement of the tibia, one of the long bones located in the lower leg. However, any sudden twist or change of direction may cause it to tear. Some of the symptoms of ACL injury include:
- Hearing or feeling a “pop” coming from the knee
This is often the first sign of an ACL tear. The “pop” is typically experienced at the moment of injury and is a sign that the ligament has been severely stretched or torn.
- Tenderness along the joint line
Following the injury, you may notice tenderness when pressing along the sides of the knee joint where the ligaments are located. This tenderness is due to inflammation and bruising from the ligament damage.
- Pain and swelling of the knee
Swelling usually occurs within the first few hours after the injury, as a result of blood and fluid accumulating in and around the knee joint. The swelling and pain can make it difficult to move the knee normally.
- Reduced range of motion and difficulty walking
Swelling and pain from the ACL tear may severely restrict the knee’s ability to bend and straighten, limiting overall mobility. You may also experience discomfort or instability when trying to walk.
- A sensation of something tearing inside the knee
At the moment of injury, you might feel as though something inside the knee has snapped or torn apart, which corresponds to the actual tearing of the ACL.
How Is ACL Tear Diagnosed?
Usually your doctor will have a strong suspicion that you have torn your ACL. However, he will usually proceed to order an MRI scan for further evaluation. Here are some other ways that ACL tear can be diagnosed:
Physical Examination
Your doctor may perform an in-depth examination of your symptoms and review your medical history to determine the cause of your injury.
To rule out ACL tear, your doctor may use the Lachman test to assess the integrity of your anterior cruciate ligament
Imaging Test
Imaging procedures such as x-rays, ultrasounds, MRIs, and CT scans may be recommended by your doctor to see the interior structure of your knee and provide a conclusive diagnosis of an ACL tear.
When Should You Consider ACL Surgery
Deciding whether to proceed with ACL surgery depends on how the injury affects knee stability, daily function, and long-term joint health. While some individuals may manage well with rehabilitation alone, others may continue to experience instability that interferes with movement or activity.
Persistent Knee Instability
If the knee continues to feel unstable or gives way during walking, turning, or light activity, this may indicate that the ligament is not providing sufficient support. Ongoing instability can increase the likelihood of further injury to surrounding structures.
Difficulty Returning to Sports or Active Lifestyles
Individuals who participate in sports or activities that involve pivoting, jumping, or sudden directional changes may find it difficult to return safely without a stable ACL. In such cases, surgery may be considered to support knee function during these movements.
Associated Knee Injuries
ACL tears can occur alongside injuries to the meniscus, cartilage, or other ligaments. When multiple structures are involved, surgical management may be considered to address overall knee stability and reduce the risk of further joint damage.
Limited Progress with Rehabilitation
Some patients may undergo physiotherapy but continue to experience instability, discomfort, or functional limitations. When structured rehabilitation does not lead to satisfactory improvement, surgery may be discussed as a next step.
Younger or More Physically Active Individuals
Younger individuals or those with higher physical demands may be more likely to consider surgery, particularly if they wish to return to activities that place stress on the knee. The decision is usually guided by lifestyle needs and functional goals rather than age alone.
Treatment Options for ACL Tears
The approach to managing an ACL tear depends on the severity of the injury, the level of knee stability, and the individual’s activity needs. Treatment generally falls into two broad pathways, with the goal of restoring function and reducing the risk of further joint issues over time.
Non-Surgical Management
Not all ACL tears require surgery. In some cases, especially with partial tears or when the knee remains relatively stable, non-surgical care may be considered.
This approach typically focuses on strengthening the muscles around the knee to improve support and control. Physiotherapy programmes are structured to restore range of motion, build strength, and help patients return to daily activities safely. Some individuals may also use knee braces during certain activities to provide additional support.
Non-surgical management may be more suitable for those with lower physical demands or for individuals who do not frequently engage in activities that involve pivoting or sudden directional changes.
Surgical Reconstruction
For complete ACL tears or cases where the knee remains unstable, ACL surgery may be considered. The procedure involves reconstructing the ligament using a graft to restore stability within the joint.
Surgical management is often discussed when patients experience repeated episodes of the knee giving way, or when they aim to return to sports and activities that place higher demands on knee stability. It may also be considered when there are associated injuries affecting other structures within the knee.
The decision between surgical and non-surgical treatment is guided by a clinical assessment, taking into account the individual’s symptoms, lifestyle, and functional goals.
ACL Surgery Recovery Process
Recovery after ACL surgery is gradual and structured, with each phase focusing on restoring movement, strength, and stability in the knee. The timeline can vary depending on individual healing, rehabilitation progress, and activity goals, though most patients follow a staged approach guided by physiotherapy.
| Phase | What to Expect | Focus |
|---|---|---|
| Early Recovery (0 to 2 weeks) | Swelling and discomfort are common. Crutches may be used, and movement is kept gentle. | Reduce swelling, protect the knee, begin light range of motion exercises |
| Early Rehabilitation (2 to 6 weeks) | Gradual increase in movement and weight-bearing. Daily activities become more manageable. | Improve knee mobility, activate muscles, restore basic function |
| Strengthening Phase (6 weeks to 3 months) | The knee becomes more stable with improved strength. Structured exercises become more progressive. | Build muscle strength, improve balance and control |
| Advanced Rehabilitation (3 to 6 months) | Higher-level exercises are introduced, depending on recovery progress. | Enhance coordination, prepare for more demanding movements |
| Return to Activity (6 to 9 months or more) | Some individuals may begin returning to sports or higher-impact activities, based on assessment. | Regain confidence, support safe return to activity |
Recovery does not follow a fixed timeline for everyone. Progress depends on factors such as adherence to rehabilitation, overall health, and the demands of daily or sporting activities. Regular follow-up helps guide each stage of recovery and adjust the programme where needed.
Anatomy of the Knee Joint
The knee joint is a hinged joint, made up of 3 bones: the femur (thigh bone), the tibia (shin bone) and the patella (kneecap).
As the knee joint is a hinged joint, the main movement that occurs at the knee is in one plane – bending and straightening. However, a little bit of rotation does occur when the knee is fully straightened.
The knee joint is covered with a smooth cartilage that ensures frictionless movements. In addition, 2 crescent-shaped cartilaginous structures known as meniscii (or meniscus is the singular form of the word) exist between the femur and the tibia.
The menisci help to enhance conformity between the femur and the tibia, but also act as shock absorbers during impact experienced during weight bearing.
Four (4) main ligaments attached on each end to the femur and tibia help to maintain stability of the joint. There are 2 collateral ligaments and 2 cruciate ligaments. The ACL and its counterpart, the PCL (posterior cruciate ligament) are arranged in a cross pattern when viewed from the side.
The ACL is so named because it is placed in front of the PCL (hence the term “anterior”), and originates from the back of the femur, travels distal and anteriorly, and is attached to the top of the tibia, within the knee joint.
The collateral ligaments prevent the knee from opening up side to side, while the cruciate ligaments prevent the tibia from sliding forwards and backwards. The cruciate ligaments, however, have an arguably even more important function; they also prevent excessive rotatory movements from occurring at the knee joint.
Additional Questions About ACL Surgery
Can I walk immediately after ACL surgery?
Most patients are able to walk with support, such as crutches, shortly after ACL surgery, depending on comfort and stability. Weight-bearing is usually introduced gradually, guided by your recovery plan and physiotherapy progress.
Will my knee feel normal again after surgery?
The knee can regain stability and function over time, though it may not feel exactly the same as before the injury. Recovery depends on rehabilitation, muscle strength, and how well the knee adapts during daily activities, often with guidance from an orthopaedic specialist in Singapore.
Do I need physiotherapy after ACL surgery?
Physiotherapy is a key part of recovery following ACL reconstruction. It helps restore movement, rebuild strength, and support safe return to activity, often under the direction of a sports orthopaedic care approach.
Can I delay ACL surgery if I have a tear?
In some cases, surgery can be delayed if the knee remains stable and symptoms are manageable. An orthopaedic doctor can assess whether non-surgical management is appropriate based on your activity level and knee function.
What happens if an ACL tear is left untreated?
An untreated ACL tear may lead to ongoing knee instability, which can increase the risk of further injury to cartilage or other structures. A consultation with an orthopaedic specialist can help determine the potential impact based on your condition.
Is ACL surgery a day procedure?
ACL reconstruction is commonly performed as a day surgery, meaning patients can return home on the same day if there are no complications. Your ortho team will provide guidance on post-surgical care and monitoring.
Will I need follow-up appointments after surgery?
Follow-up visits are part of the recovery process to monitor healing and adjust rehabilitation if needed. These reviews are typically scheduled with your orthopaedic surgeon in Singapore to track progress over time.
Can I return to work after ACL surgery?
Return to work depends on the nature of your job and recovery progress. Sedentary roles may resume earlier, while physically demanding work may require more time, with advice from an ortho specialist in Singapore to ensure a safe transition.
What is an ACL graft?
An ACL graft is a length of tendon used to replace the ruptured ACL ligament. Although ligaments and tendons serve different functions in the body, they are structurally similar as both consist of lengths of collagen, bundled together lengthwise.
Ligaments are not used for ACL reconstructions because ligaments in the human body are generally too short to be used. Those that may be long enough are too difficult to harvest and cannot be done without causing severe compromise to the patient.
Some tendons, on the other hand, can be readily harvested and used for ACL reconstructions without causing significant disability to the patient. Hamstring tendons are a good example of tendons that can be sacrificed, and are, in fact, the most common tendons harvested from a patient for ACL reconstructions.
Two (2) types of grafts are generally used for ACL reconstructions: autografts and allografts. Autografts are grafts harvested from the patient himself. As mentioned above, hamstring grafts are the most commonly utilized grafts in modern day ACL reconstruction.
However other grafts such as the middle third of the patellar tendon, part of the quadriceps tendon and even tendons from the lower leg have been used.
Allografts, on the other hand, are harvested from donors who have passed on. These allografts are then carefully screened for any transmissible diseases that the donor might have suffered from when alive.
If found suitable, then are then thoroughly cleaned and packed in sterile packages, ready to be used commercially.
Will I be able to return to my normal sporting activities?
Most people return to sporting activities somewhere between 9 to 12 months. This will depend on the appropriate and successful completion of your rehabilitation program.
Many factors also need to be considered before going back to playing sports as there are risks of reinjuring the reconstructed ACL. Every patient’s recovery process is different, but following your rehabilitation plan closely is important to regain strength and stability in the knee as well as improve your balance, agility and jumping skills.
What are the Risks and Complications from ACL Reconstruction Surgery?
- Infection at the surgery site
- Infection or viral transmission from allograft (cadaver) tendons
- Bleeding
- Numbness
- Blood clot
- Knee instability, stiffness, and kneecap pain.
What Are The Factors Contributing to An Anterior Cruciate Ligament Injury in Non-Athletes?
- Age is over 40
- Falling from heights
- Women are more prone to ACL injury due to their unique anatomical structure
- Missing a step in a staircase
Can my ACL heal on its own?
An MCL or medial collateral ligament tear can heal without surgery. Some partially ruptured ACLs, especially in children and teenagers, may also heal without surgery. However, complete ACL tears seldom heal due to the lack of blood flow.
What is the difference between an ACL sprain and an ACL tear?
When is ACL surgery necessary?
Surgery for an ACL injury is generally recommended if there is a complete tear of the ligament, especially in individuals who lead active lifestyles or engage in sports that require pivoting movements. Surgery may also be necessary if the knee continues to experience instability despite appropriate physiotherapy and rehabilitation. The decision for surgery takes into account the patient’s activity level, age, overall health, and personal goals. Ultimately, the aim is to restore stability to the knee to prevent further joint damage and return to pre-injury levels of activity.
How soon should an ACL tear be repaired?
The timing of surgery for an ACL tear can vary. Immediate surgery is not typically recommended as it may lead to increased scar tissue formation, which can complicate recovery. It’s generally advisable to wait until the swelling has subsided, and the patient has regained some range of motion through pre-surgery rehabilitation. This approach helps to ensure a better surgical outcome and a smoother post-operative recovery. The decision on timing should be made in consultation with an orthopaedic specialist, considering both ACL tear symptoms and treatment goals tailored to the individual’s circumstances.
What is ACL Reconstruction Surgery?
What is an ACL graft?
What is recovery like?
Will I be able to return to my normal sporting activities?
How can I get the best results after an ACL Reconstruction Surgery?
What are the Risks and Complications from ACL Reconstruction Surgery?
What Are The Factors Contributing to An Anterior Cruciate Ligament Injury in Non-Athletes?
How long will I recover from ACL reconstruction surgery?
Can my ACL heal on its own?
What is the difference between an ACL sprain and an ACL tear?
When is surgery necessary?
How soon should an ACL tear be repaired?
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