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The anterior cruciate ligament is a major stabilising ligament in the knee. The strong, rope-like structure is located in the middle of the knee and runs from the femur to the tibia. Unfortunately, tearing to this ligament does not usually heal, which can lead to the knee feeling unstable. Due to recent advances in arthroscopic surgery, ACL reconstruction is now a common procedure with minimal surgical incision and a low risk of complications.

ACL injuries usually occur due to a non-contact pivot incident but can also be suffered during contact sports. Classic features of a patient’s injury history include: the knee giving way, hearing a pop, feeling a clunk, twisting the knee, severe pain, being unable to play on, and experiencing swelling within four hours.

The ACL is usually unable to repair itself as it is within the knee joint where the joint fluid prevents healing. Surgery consists of reconstructing the ligament using another tendon from elsewhere in the body. The procedure requires the removal of the torn ligament remnants and replacing it with tissue taken from another tendon in the leg, usually the hamstring or patellar tendon.

Doctors recommend ACL reconstruction only when knee instability affects daily life, if the patient does a physical job or they wish to continue playing sports. Professor Ali Ghoz is an esteemed voice in orthopaedics and his publications have been included in the Bulletin of the Royal College of Surgeons of England and The Open Orthopaedics Journal.

Swelling must be resolved and the knee must have its full range of movement before surgery is performed. This is typically within 6-8 weeks following the injury. 

As with any type of surgery, ACL reconstruction includes some small risks to patients, such as infection, a blood clot, or knee pain, weakness or stiffness. Even after surgery, the knee may never return to the way it was before the injury. However, in 80% of cases, ACL surgery fully restores knee function.