ACL Surgery Singapore
MBBS (SINGAPORE) MMED (ORTHO) FRCS ED (ORTH)
Dr Bryan Tan is a fellowship-trained orthopaedic surgeon with 20+ years of experience in the surgical treatment for sports and non-sports related ACL tears and injuries. Prior to private practice, he was a consultant orthopaedic surgeon in National University Hospital (NUH), Singapore.
Anterior cruciate ligament (ACL) tears are extremely common injuries usually sustained during sports. Thousands of ACL reconstruction surgeries are performed in Singapore every year.
ACL tears result in instability of the knee which predisposes the patient to frequent twisting injuries to the knee which will put other structures in the knee at risk of repeated injuries. In addition, the risk of developing arthritis in the ACL-injured knee is higher than in an uninjured knee.
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
- Tenderness along the joint line
- Pain and swelling of the knee
- Reduced range of motion and difficulty walking
- A sensation of something tearing inside the knee
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.
How To Treat ACL Tear?
Most complete ruptures of the ACL require surgical reconstruction. In some patients, the ACL rupture may be partial. In these patients, they may be able to cope without requiring any surgery, depending on their symptoms.
I do not, however, recommend surgery for every patient who may have suffered a complete ACL tear. I have, in the past, advised patients against ACL surgeries. An example would be a slightly older patient, perhaps, in his mid 50s and is not particularly active. Being inactive, it is not likely that an ACL deficient knee will impair him in any way.
Most young and active patients, however, will be better off undergoing an ACL reconstruction surgery.
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.
Frequently Asked Questions
What is ACL Reconstruction Surgery?
ACL reconstruction is a commonly performed surgical procedure that reconstructs the torn ACL so that the function of a normal ACL can be replicated. The end result is to have the torn ACL replaced by a “new” ACL.
ACL Reconstruction is a procedure with a minimally invasive approach. During surgery, an arthroscope (tube-like video camera) and other surgical tools are inserted via small incisions in the knee joint space. Your damaged ACL will then be removed and replaced with a segment of tendon from another part of your knee (graft). The graft acts as a base on which new ligament tissue can grow.
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.
What is recovery like?
Early recovery includes wound care and icing to reduce swelling. Braces and crutches are also used according to the surgeon’s discretion.
Successful long-term recovery is often dependent on the patient’s commitment to physical therapy and rehabilitation. These exercises begin soon after surgery. Goals for physical therapy and rehabilitation include increased mobility and strengthened muscles and tendons.
Recovery exercises are performed in a graduated fashion, getting patients to progressively weight bear, walk unaided, jog, jump, run and finally get back to their sport of choice.
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.
How can I get the best results after an ACL Reconstruction Surgery?
It is important to follow and complete your recommended rehabilitation plan in order to achieve ideal results after surgery.
What are the Risks and Complications from ACL Reconstruction Surgery?
For most patients, the risk of any serious adverse event happening is less than 1-2%. However, as every patient is different, it is important that you have a detailed chat with your doctor with regard to your risk.
Some of the risks of ACL Reconstruction include:
- 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?
There are several factors that may contribute to an individual’s susceptibility to ACL injury:
- 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
How long will I recover from ACL reconstruction surgery?
It usually takes nine months to recover after the surgery. Athletes may need to wait eight to 12 months or longer to resume their sporting activities.
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.
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The following are accredited For Singaporeans, Singapore Permanent Residents and Foreigners. If your insurance is not listed, you will still be able to make claims for eligible procedures! We have experience processing claims from many other various insurance providers. Please contact us if you have any queries.
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