Knee Surgeon Perth | ACL Tear FAQ

ACL Tear

If you suffer from an injury to the anterior cruciate ligament in your knee, you may have questions about the ACL tear and the surgery you need.


Frequently asked questions

Below we have listed the answers to some of the frequently asked questions.

Often the best time to have reconstructive surgery is immediately after the injury. This is before muscle wasting and knee stiffness has occurred. This will result in the fastest recovery.

However if there has been a delay in the diagnosis then sometimes the knee has become stiff and this is not the right time to proceed with surgery. It may take several weeks of rehabilitation to restore movement before surgery can proceed safely.

A few weeks of “pre-hab” can take months off the recovery time if stiffness is an issue.

In general terms, reconstructive surgery is not urgent and can be delayed to fit around work and personal schedules. During this time, sport and change of direction activities should be avoided. It is important to continue some “straight line” fitness activities and cycling is ideal.

If there are other injuries such as a meniscal tear which might be a suitable for repair, then you may be advised to have surgery sooner rather than later.

In the great majority of cases, anterior cruciate ligament tears are complete tears of the ligament and healing capacity is very limited. One of the reasons for this is that the tear occurs in a fluid environment. The knee joint contains articular fluid which bathes the torn area and prevents healing.

Sometimes limited healing will occur and can provide an adequate level of stability. Alternatively, the ligament may heal but is longer than it should be and this can still allow for the knee joint to be unstable.

Partial tears are much less common. Even with a partial tear, the knee joint may be adequately stable and reconstruction may not be required.

The anterior cruciate ligament provides stability to the knee particularly with twisting, turning and change of direction activities. Immediately after an ACL tear, your knee will be sore but the pain will settle provided there are no other injuries. The end result of the cruciate ligament tear is an unstable knee, not a painful knee. Most people with an anterior cruciate ligament tear are unable to return to competitive sporting activities without reconstruction. Straight line activities such as walking, swimming and cycling are still possible. Cruciate ligament reconstruction surgery is undertaken to restore stability to the knee joint to improve quality of life and allow sporting activities.

It is also generally accepted that an unstable knee with a torn cruciate ligament is more likely to develop arthritis in the longer term. The risk of arthritis after an ACL tear is increased but that does not mean that it occurs in all patients.

There are many options for graft tissue but the commonest in use today is hamstring tendon tissue. Although much attention is paid to graft choice, it is not the most important factor in the success of surgery. Read my article on ACL graft choice.
Most patients use crutches for one week but take weight on the leg (partial weight bearing) immediately. You should be full weight bearing without crutches after one week if possible.
I advise that a brace should be worn for three weeks following a hamstring reconstruction but I do not generally use a brace for other graft types.
In case of an ACL tear and an ACL reconstruction, it is desirable to have a physiotherapist supervise your recovery. Their job is to instruct you on the exercises to perform. You then undertake those exercises for twenty to thirty minutes, three times a day in the first few six weeks. I would advise that you see a physiotherapist every two weeks for the first six weeks, and then reducing frequency thereafter.
You are not fit to drive until six weeks, with the exception that if you had a left knee ACL reconstruction, you can drive an automatic after three weeks. You need to be able to stand on 1 leg for 1 minute to be fit to drive.

It is safe to allow at least one week before you resume office duties. Light physical duties can resume at six weeks post surgery and a manual occupation is usually deferred until twelve weeks post surgery.

If your occupation involves ladders, scaffolding or roofs, then these duties should be held off until four months post surgery.

Swimming and exercise bike can start six weeks post surgery. Jogging starts approximately twelve to fourteen weeks post surgery.

A return to competitive sports and twisting and turning activities is at eleven months post surgery.


Related topics

ACL injury

An ACL injury is one of the most common serious knee injuries and involves a complete tear or rupture to the Anterior Cruciate Ligament (ACL). The human knee is vulnerable to injury because it connects two very long bones, the femur (thigh bone) and the tibia (shin bone). These two long levers can exert incredible force at the knee joint.

ACL reconstruction

The aim of ACL reconstruction surgery is to stabilise your knee joint. A torn Anterior Cruciate Ligament can’t heal by itself and causes knee joint instability and a feeling of giving way or insecurity. Longstanding knee joint instability causes further damage to the knee cartilage and may cause a torn meniscus.

Orthopaedic surgeon Perth

About Perth Orthopaedic Surgeon Dr David Colvin

Dr David Colvin, a Perth orthopaedic surgeon with a special interest in shoulder and knee injuries, understands that a painful joint or a joint that doesn’t function properly, can have a huge impact on your quality of life.