ACL Tears

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ACL Tears

Twisted your knee during football? Or landed awkwardly during volleyball? There’s a chance you could have done your anterior cruciate ligament or ACL. Patients often report hearing or feeling a “pop” followed by pain and swelling in the knee. ACL tears most commonly occur with pivoting, rapid deceleration, cutting movements or twisting injuries. Here are some common questions to help you discover more about the ACL and the treatment options available.

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1. What is the Anterior Cruciate Ligament or ACL?
The ACL is a major ligament in the knee. It is one of 2 cruciate ligaments, the other being the posterior cruciate ligament or PCL. The ACL provides stability by limiting forward movement of the femur on the tibia. It also provides rotational control. Without an intact ACL, the knee may feel loose and wobbly. An injured or torn ACL is a common cause of knee pain and swelling.

2. What are symptoms of ACL tear?
Unlike other injuries, patients who suffer an ACL tear do know instantly that it’s a serious injury. Patients often report hearing or feeling a “pop” followed by pain and swelling in the knee. They are unable to complete the game and will need assistance off the court. With knee swelling and pain, it is often difficult to bend the knee or walk for the next few days.

Symptoms you may experience include:

3. What causes ACL Tears?

Athletes are can easily damage their ACL. Football, basketball, badminton, volleyball, and sports that use cutting maneuvers. Sports requiring pivoting and twisting movements of the knee can place the ACL under stress. Besides sports men and women, we see patients who are working individuals with less time to pre-condition their physique before participating in such sports.

Interestingly, women are four times as likely to sustain an ACL tear compared to men. Research has suggested a variety of reasons. This includes factors with the anatomical shape of the pelvis, lower limb alignment, and native tension in the ligaments. Other factors include differences in the techniques for jumping and landing.

4. How is ACL Tear diagnosed?
Patients who present with the symptoms above after playing sport may show signs of an ACL tear. The knee is often painful and swollen in the initial phase after injury. Your surgeon will check the stability of your knee. MRI scan of the knee is often needed. The scan will show the location of the tear, and if it is partial or complete. It allows the surgeon to survey the overall condition of the knee, including the meniscus and cartilage.

5. What are complications of an ACL Tear?
Suffering an ACL tear suggests considerable force has passed through the knee. Besides the ACL, other ligaments, meniscus, and cartilage injuries can be sustained at the same instance. These other injuries can be picked up on the MRI scan.

If the injuries are not addressed, the knee can remain unstable particularly during sports. Damage to other structures in the knee can have long term effects such as early osteoarthritis and chronic pain.

6. What is the benefit of surgery for an ACL Tears?
Surgery allows the ACL to be reconstructed or repaired. It allows the surgeon to also address other injuries within the knee such as a torn meniscus or cartilage defect. The surgery aims to restore the anatomy but will require dedicated physical therapy from the patient to reap the full benefits.

Patients often choose surgery as they wish to return to a similar high level of sport and performance. Other patients who do not have high functional demands may choose to forgo the surgery and adjust their lifestyles accordingly. Discuss your options with your surgeon.

7. How is ACL surgery performed?
ACL surgery is done arthroscopically. It is often done as a day surgery procedure. Patients can be discharged home on the same day after surgery. Keyhole incisions are made at the front of the knee. Refer to our resource on Knee Arthroscopy for more information. Special instruments are passed through the 2 incisions to assess the knee.

To reconstruct the ACL, a graft of a tendon is needed. This can be harvested from the patient’s own hamstring, or patellar tendon. In some cases, tendon from a cadaveric donor can be obtained to reconstruct the ACL. Additional incisions will be needed to harvest and pass the graft into the knee. Surgery can take 1-2 hours depending on the complexity and structures injured.

8. What are the Risks of ACL Surgery?
ACL surgery is generally a safe procedure. Risks include infection, bleeding, post-operative swelling and stiffness. However these risks are uncommon and infrequent.

9. What is the Cost of ACL Surgery in Singapore?
The professional fees for Meniscus Surgery can range from $8,000 to $11,000 at a private hospital according to MOH’s Historical Transacted Bill Sizes and Fee Benchmarks. This is however before taking into account your insurance (e.g. Integrated Shield Plans, Medishield Life) and MediSave payouts. In addition, Dr Kau is on the Panel for most major local insurers. Speak to our team today and we can guide you through the claims process.

10. What is the Recovery after ACL surgery?
Patients are able to stand and take steps once the anaesthetic wears off on the same day. You can be discharged the same afternoon or next morning if you prefer. You will need crutches or a walking aid for the first 2-4 weeks. A knee brace is required in the first 6 weeks. Physiotherapy will aim to reduce swelling and help to strengthen the muscles around the knee. Return to everyday activities depends your pre-existing condition and complexity of the injury. Dr Kau will discuss with you the best way forward and tailor a recovery plan for you.