I’ve torn my ACL – do I have to have surgery?

Written by: Mr James Donaldson
Published: | Updated: 03/02/2020
Edited by: Bronwen Griffiths

The anterior cruciate ligament (ACL) is a major ligament in the knee, which if torn due to injury or accident requires medical attention. Depending on how active you are, the extent of the injury and your lifestyle there are different treatment options available. Mr James Donaldson, an expert orthopaedic surgeon, discusses when surgery to repair an ACL injury is recommended and when it may not be necessary.

How do you know if you have injured your ACL?

An injury to the ACL is often from trauma and results in pain, swelling and stiffness within a few hours. Some patients report hearing a ‘pop’ sound. The knee may also feel unstable in the weeks afterwards.

How is an ACL tear treated?

An ACL tear is often treated with surgical reconstruction. The gold standard is harvesting your own hamstring tendons and fashioning a new ligament out of them. The new ligament is then inserted into the knee arthroscopically. Performing a reconstruction arthroscopically is minimally invasive, making use of an arthroscope (a slender, ocular device with a camera) which is inserted into a small incision. This means that the joint does not have to be opened up fully. Using the arthroscope, the surgeon is able to view the joint on a video monitor. This method has faster recovery times, and a reduced chance of complications arising.

Is surgery always required for an ACL injury?

Surgery is not always necessary. Some patients, particularly with less sporting ambitions, may recover sufficiently with physiotherapy alone. Whilst surgery is usually the best option for young, active and athletic people, not all people with ACL injuries need or want to go through surgery. Luckily, with a committed physiotherapy routine, the ACL can begin to heal naturally. 

How long is the recovery from ACL reconstruction?

Patients can walk and gently exercise the knee straight away, but it takes some weeks for the swelling and pain to settle fully. It may take 6 to 9 months before returning to full sporting activity as the new ligament needs to heal and the knee must be rehabilitated.

If you have injured your ACL and need like to see a specialist or would like to learn more, make an appointment now.

By Mr James Donaldson
Orthopaedic surgery

Mr James Donaldson is one of London's most highly-skilled orthopaedic surgeons. Operating from the Royal National Orthopaedic Hospital, he has a special interest in hip replacements, knee replacements, using stem cells for cartilage replacements, soft tissue knee surgery, arthroscopic knee surgery and ligament reconstruction. He is also the clinical director of the joint reconstruction unit at the Royal National Orthopaedic Hospital.

Mr Donaldson was awarded his first medical qualification at University College London Medical School in 2002, receiving a certificate of merit in his MB finals. He then worked on the Royal National Orthopeadic Hospital rotation until 2013 to complete his training. Mr Donaldson went on to complete two sub-specialist fellowships: a one-year international fellowship in Toronto, Canada and a six month fellowship at Stanmore on the joint reconstruction unit. He is currently a consultant orthopaedic surgeon at the Royal National Orthopeadic Hospital. He additionally worked as consultant at the Royal Free Hospital in Hampstead. He is on the clinical governance committee at Stanmore and also sits on a number of multidisciplinary national meetings for complex case referral. 

Throughout Mr Donaldson's illustrious career, he has been awarded ten academic prizes including a surgery distinction in 2000 and a pharmacology certificate of merit in 1998. Later on his career, he was awarded the Royal College of Surgeons Preiskel Elective Prize in 2001 and the Jacques Duparc prize from the European Federation of National Associations of Orthopaedics and Traumatology in 2009. He has written numerous textbook chapters and articles in peer-reviewed journals and has co-authored a website for junior orthopaedic trainees and medical students. He is a member of a number of professional bodies such as the British Orthopaedic Association and the Royal College of Surgeons.

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