Considering every aspect of anterior cruciate ligament (ACL) reconstruction

Written by: Mr Ayaz Lakdawala
Published: | Updated: 05/11/2021
Edited by: Karolyn Judge

Reconstructing the anterior cruciate ligament (ACL) can be a beneficial procedure for people who want a stable knee and an active lifestyle without more pain, injury or loss of strength and movement. However, there are various elements to consider before going ahead with this operation.


Leading orthopaedic surgeon Mr Ayaz Lakdawala, who has years of experience in diagnosis and management of orthopaedic knee conditions and sports injuries, considers different treatment options, risks and benefits and the surgical – and non-surgical - process involved in ACL. In part two, he looks at what should be considered before undergoing the procedure. 


Anterior cruciate ligament reconstruction is an operation to remodel the torn anterior cruciate ligament (ACL) and restore stability to the knee joint. The ACL is one of the main stabilising ligaments of the knee and also provides significant feedback information (proprioception) to the muscles surrounding the knee, allowing for coordinated activities.


It is very common for injuries to occur while doing sporting activities, particularly football, rugby, netball and skiing. ACL cannot repair itself, so when it has been torn it often leads to instability in the knee, which patients report as ‘the knee giving way’. Sometimes patients may experience pain or an ongoing lack of confidence in their knee preventing them from returning to sporting activities. Patients with this injury need thorough clinical assessment by a knee specialist.


Knee in a black brace, being assessed using technology


Why would I need an ACL reconstruction?

Not everyone with ACL rupture will require surgery. I will assess your knee and will go through your treatment options and explain what would work best for you.


Surgery is more likely to be recommended in certain situations. For example, if you:


  • Play sports to a high level; such as ones that include a lot of twisting and turning like football, rugby or basketball, and you want to get back into it


  • Have a very physical or manual job, for example you’re a firefighter, police officer or work in construction


  • Have damage to other parts of your knee, which could also be repaired with surgery



How do I make a decision about having operation to reconstruct ACL?

I will talk you through the risks and benefits of surgery and explain alternatives to having an operation. Having ACL reconstruction could help to stabilise your knee and relieve pain. It might mean you’re able to return to your usual level of activity or sports. There is increasing evidence, particularly in children and teenagers but less certain in later adulthood, that stabilising the knee can protect it from further impairment such as cartilage damage and early-onset knee degeneration.


However, you need to prepare yourself for the fact that it can take six months to fully recover from ACL reconstruction and often nine months to return to full sports. There is a structured physiotherapy after the operation to ensure a successful outcome. You’ll also need to stick to the exercise regime given to you to help you get back to the level of sporting activity you want. As with all surgical procedures, there is also a low risk of complications, and there is a small possibility that the procedure may not work.


I will explain exactly what will happen during the procedure, what to expect afterwards and the risk of potential complications. You will be given time to make sure you understand everything and have an opportunity to ask any questions. If you’re happy to go ahead with the procedure, I will make arrangements for your surgery to take place and you will need to sign a consent form. You will have ample opportunity to discuss any of your concerns and ask questions about your operation and after care. I will discuss with you the choice of grafts used for reconstruction but hamstring grafts are commonly used.



Timing of surgery

Surgery isn’t usually done straightaway after the injury, to allow some time for any swelling to go down. Initially, you’ll usually have physiotherapy. The ideal time for surgery is when the swelling has gone down and you have regained full or near normal range of knee movements.



Are you considering ACL surgery? Visit Mr Ayaz Lakdawala's Top Doctor's profile here for his expert advice.

By Mr Ayaz Lakdawala
Orthopaedic surgery

Mr Ayaz Lakdawala is an extensively trained and highly skilled consultant orthopaedic surgeon. With over 20 years of professional experience, he has developed leading expertise in the diagnosis and management of orthopaedic knee conditions and sports injuries. He performs a high volume of knee surgery and regularly receives referrals from colleagues for a second opinion and complex cases.

Mr Lakdawala ensures that all patients receive first-class and personalised care, which is reflected in excellent patient outcomes and reviews. His surgical expertise consists of, but is not limited to, knee replacement surgery (partial and total), knee arthroscopy, anterior cruciate ligament (ACL) reconstruction, knee ligament reconstruction (MCL, LCL PLC), meniscal repair and cartilage regeneration procedures.

In addition, Mr Lakdawala is one of the very few surgeons who use Ortho-pilot™, a computer navigation programme for improved surgical accuracy during knee replacement. As the only surgeon in Warwickshire that offers computer navigation knee replacement surgery, patients are referred to him from across Warwickshire and the West-Midlands for complex knee replacements.

He is also an expert in non-surgical procedures, such as joint injections. What's more, he provides personalised treatment for patients with sports injuries, from leisure sports players to professional athletes, and he ensures he stays up-to-date with the latest techniques. He also has links with specialist exercise and conditioning coaches to help patients return to sports after injury or operation.

During his training, Mr Lakdawala was selected for higher specialist training in trauma and orthopaedics in the West Midlands, where he trained at the internationally known hospitals of the Royal Orthopaedic Hospital and Queen Elizabeth Hospital. After completing his training, he was appointed the post of senior clinical fellow at world-renowned knee fellowship centres at King’s College Hospital, London, and the Exeter Knee Reconstruction Unit of the Royal Devon and Exeter Hospital NHS Trust.

His leading knowledge and skill have led to him being appointed as the Regional Director for Royal College of Surgeon of England (RCSE) and he also chairs the professional affairs board in the West Midlands. His work with the RCSE involves improving surgical standards, patient care and surgical education and training. He is also an examiner for the Warwick Medical School and trainer for junior doctors and senior registrars.

Mr Lakdawala's is also recognised for his research. He has published extensively in regional and international peer-reviewed journals. He is also regularly invited to national and international conferences and meetings to present his work.

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