ACL Reconstruction

Professor Al Muderis utilises a minimally-invasive alternative to traditional ACL reconstruction known as All-Inside ACL Reconstruction, which involves replacing the damaged ACL with a tendon graft. The ruptured ligament is removed, and the bone is prepared to accept the new graft, which acts as a replacement for the old ACL. 

All-Inside ACL reconstruction does not require the creation of a tibial tunnel. Instead, a specialised tool is used to create a tibial socket without violating the tibial cortex. Grafts may be autologous hamstring or patellar tendon grafts, cadaveric donor grafts, and synthetic grafts (LARS).

Preparation prior to surgery

• You will receive a thorough health assessment: including medical history. You may be advised to modify certain lifestyle factors and you may be referred to another specialist. You may be asked to stop taking certain medications as your surgery date approaches. X-rays, CT scans, and MRIs will be used to evaluate your condition and plan your surgery.  
• Skin and bowel preparation: On the evening before your surgery, you will be asked to wash your leg using the sponge provided at your pre-admission clinic. A skin test may be administered if an iodine allergy is suspected. You will also be provided medicine to help you evacuate your bowels prior to surgery.
• Patient education: if neccessary, you may speak with a physiotherapist who can advise you on post-operative mobility. 

On the day of the surgery

• You will be asked to complete your surgical paperwork and will meet with the anaesthetist.
• The surgical site will be prepared.
• You will be administered general or spinal anaesthesia.
• A small incision will be made through which the arthroscope will be inserted
• Small tunnels are drilled in the tibia and femur to place the graft. These tunnels serve as anchor points for the new ACL.
• The graft is threaded through the tunnels and secured in place using screws or other fixation devices.

• The incisions are closed with sutures or staples, and dressings are applied. 

After your surgery

• Wound care: your incisions will be closed with absorbable cosmetic sutures and covered by a waterproof dressing. These will remain intact for 7-10 days. You may clean the wound gently with warm water and soap, being careful to dry it thoroughly. 
• Pain and swelling: You may experience mild to moderate pain in the knee. You will be prescribed painkillers to manage these symptoms. Inflammation can be controlled by icing (15 minutes per hour maximum).
• Mobilising: this will be guided by the degree of surgical intervention. Crutches may be used initially and some limping is expected for the first few weeks of recovery.
• Aftercare: after 6 weeks, you will be asked to complete further checks to assess healing, and at three, six and twelve months after your surgery for the same reason. 
• Physiotherapy: a tailored program will help you to build strength, flexibility and mobility around your knee. You should engage in passive and active range of motion exercises to ensure full extension is achieved and maintained within one week after surgery. The goal is to reach 90 degrees of flexion by week two, with progression to full flexion as tolerated.