ACL Reconstruction in Singapore: What To Expect On Your Road To Recovery

By Chun Kiat

An ACL injury involves a tear or sprain of the anterior cruciate ligament, one of the strong bands of tissue that connect the thigh bone to the shinbone. Recovery from an ACL injury typically involves a combination of rest, physical therapy, and sometimes surgery, depending on the severity of the tear. Physiotherapy focuses on strengthening the muscles around the knee to provide better stability and support. A well-structured rehabilitation program is crucial to help patients regain full range of motion and return to their previous level of activity. For those who require surgery, the procedure usually involves reconstructing the torn ligament using a graft, which can be sourced from the patient's own body or from a donor. Post-surgery, a dedicated rehabilitation plan is essential to ensure a successful recovery and to minimise the risk of re-injury.

Preventative measures can also be taken to reduce the risk of an ACL injury. These include proper training techniques, strength training, flexibility exercises, and the use of appropriate footwear. Athletes are encouraged to develop good landing techniques and to focus on exercises that improve balance and coordination.

Overall, while an ACL injury can be a significant setback, with the right treatment and rehabilitation, many individuals are able to return to their favourite sports and activities, often stronger and more resilient than before.

The Causes of Injuries

In Singapore, ACL injuries typically happen during sports and fitness activities that place stress on the knee, including:

• Sudden Slowing Down and Changing Direction:

  Quick changes in movement can strain the ACL.

• Pivoting with Your Foot Firmly Planted:

  Twisting motions while the foot is fixed can cause the ligament to tear.

• Landing Awkwardly from a Jump:

  Incorrect landing techniques can put excessive force on the knee.

• Stopping Suddenly:

  Abrupt stops can strain the knee joint.

• Receiving a Direct Blow to the Knee or Having a Collision:

  Impacts, such as a football tackle, can damage the ACL.

The Symptoms

An ACL injury typically presents with several distinct symptoms, including:

A Loud Pop or a “Popping” Sensation in the Knee:
Many individuals report hearing or feeling a pop at the time of the injury.

Severe Pain and Inability to Continue Activity:
The pain can be intense and may prevent further movement or activity immediately after the injury.

Rapid Swelling:
Swelling around the knee occurs quickly, often within a few hours.

Loss of Range of Motion:
The knee may become stiff, and bending or straightening it fully may be difficult.

A Feeling of Instability or Giving Way with Weight Bearing:
The knee may feel unstable or the sensation that the knee is giving way when attempting to stand or walk.

These symptoms indicate a possible ACL injury and warrant immediate medical evaluation for proper diagnosis and treatment. Ignoring such symptoms could lead to further complications, potentially exacerbating the injury and prolonging recovery time. It's crucial to consult with a healthcare professional who can recommend imaging tests, such as an MRI, to confirm the diagnosis and discuss the best course of action. Treatment options may range from physical therapy and rehabilitation exercises to surgical intervention, depending on the severity of the injury. Early and appropriate management can significantly improve outcomes, helping individuals return to their normal activities and prevent future injuries.

Myths/Facts

The ACL tear is a very common sports injury, but it can happen to both athletes and non athletes as well. If you tear your ACL it's not always necessary to go straight to surgery.

Myth 1: Only Athletes get ACL Tears 

Both average people and professional athletes can suffer from an ACL tear. A simple misalignment of the knee can cause a pop or snap sound, often accompanied by intense pain, bringing an abrupt halt to your favourite sports activities—at least temporarily.

Myth 2: These Injuries are only caused by blunt-force trauma 

All it takes is a turn in the wrong direction when your foot lands to cause an ACL injury. This small misstep can lead to a cascade of consequences, from swelling and intense pain to a long and arduous recovery process. Athletes, in particular, are well-acquainted with the risks associated with such injuries. However, it's not just elite sportspeople who suffer; anyone can be vulnerable in everyday activities.

Myth 3: An ACL tear will end your sports career 

An athlete's career may not always be ruined by an ACL tear, but it does happen occasionally. In other cases, it might keep you off the field for a while and force you to prioritise your own health, but you could still fully recover and make a full recovery before returning stronger than ever. There's no way to be certain because everyone is unique. A rehabilitation programme that is adhered to will guarantee the best possible outcome for your knee.

Myth 4: Surgery is the only option for an ACL tear

A full ACL tear often requires surgery, but minor tears can be treated non-surgically with RICE (rest, ice, compression, elevation) and physiotherapy. Physiotherapy helps strengthen leg muscles, stabilising the knee and compensating for the torn ACL. Treatment choice depends on tear severity and individual factors.

Myth 5: The knee has to be cut wide open 

Arthroscopy, a minimally invasive technique, is commonly used to reconstruct a torn ACL. This method involves making small incisions and using a camera to guide the surgical instruments. The benefits of arthroscopy include less scarring, reduced blood loss, and shorter recovery time compared to traditional open surgery. Because the knee isn't cut wide open, healing tends to be faster.

Additionally, non-invasive methods such as physiotherapy and muscle strengthening can aid in recovery. Physiotherapy focuses on exercises to strengthen the muscles around the knee, enhancing stability and function. This approach can help the knee heal and become stronger, potentially allowing individuals to return to their activities more quickly and safely.

Myth 6: Rehabilitation takes a long time 

Everyone is different and some people have underlying health conditions, which may mean longer healing times as well as healing can be dependent on how often one does their exercises. Ligaments, having fewer blood vessels than bones or muscles, generally heal more slowly. This reduced blood supply means less blood and nutrients are available to support tissue healing.

Myth 7: You can never run again 

The results of ACL surgery and rehabilitation can vary greatly. Some people can return to their previous level of activity by regaining strength, stability, and function in their knees through careful adherence to post-operative rehabilitation protocols. These people can confidently resume their daily activities and sports with little long-term effects.

Others, though, might still have problems even after surgery and rehabilitation. The outcome can be influenced by various factors, including the degree of the tear, related injuries, personal healing reactions, and compliance with rehabilitation regimens. Some people might discover that their knee never fully regains its strength or stability, or they might deal with chronic pain that limits their daily activities.

Do’s and Don’ts

With ACL injuries becoming more and more common within the world of sport, it is important to understand one's injury in order to maximise the effectiveness of rehabilitation. There are several Do’s and Don’ts that can be followed for effective ACL rehab.

The Do’s

• Listen To The Knee

  If you experience pain and swelling after doing any exercises or activity it is a sign to slow down and take a step back, especially regarding any impact loading activities or exercises that are being done. Ignoring this feedback can slow down efforts to improve range of movement and quadriceps activation in the early stages of ACL rehab and can actually cause it to take longer to return to sports. 

• Use The Leg Extension Machine

  The leg extension machine can be a valuable tool in ACL rehab, but it should be introduced gradually and under professional guidance to ensure it supports your recovery without compromising the healing process of the ACL graft following a procedure.

• Don't Start Running Immediately

  While running is an important goal, it should not be attempted immediately. Patience and adherence to a structured rehabilitation program are crucial to ensure proper healing, reduce the risk of complications, and promote a successful return to physical activities, including running, in due time.

• Start With Low Impact Exercises

  Starting with low-impact exercises is indeed a recommended approach to gradually regain strength, mobility, and stability in the knee joint.

The Don’ts

• Rush Into Surgery

  The decision to undergo ACL surgery should be carefully considered. While surgery may be necessary for some individuals, others may find that conservative treatments can effectively manage their ACL injury. Each case is unique, and the treatment plan should be personalised to achieve the best possible outcome for the patient.

• Wait For 3 Months Then Return To Sports

  It is essential to follow the guidance of your healthcare team and allow sufficient time for proper rehabilitation. Rushing the process can lead to setbacks and compromise your ability to perform at your best in the long term.

• Skip Strength and Agility Training

  This can compromise recovery, increase the risk of re-injury, and hinder the ability to return to sports or activities at pre-injury levels. Incorporating these components into a structured rehabilitation program is essential for achieving optimal outcomes and long-term joint health.

• Go Straight Back Into Full Training

  A gradual and structured approach to returning to full training following an ACL injury is essential for optimal recovery and reducing the risk of complications. Tailor a rehabilitation program to your specific needs and ensure a safe and successful return to sports or physical activities.

Reduce Risk of Developing Knee Pain

To reduce knee injury, especially following an ACL injury, the P.O.L.I.C.E. protocol is highly effective.

Protection involves avoiding activities that may worsen the injury and using supports like braces.

Optimal Loading promotes gentle, controlled movements to encourage healing without overloading the knee. 

Ice should be applied regularly to reduce swelling and pain. 

Compression with bandages or wraps helps control swelling and provides support. 

Elevation of the knee above heart level reduces fluid accumulation and swelling. Implementing these steps promptly can significantly aid in recovery and prevent further damage.

How Milestone Physiotherapy Can Assist

In Singapore, our physiotherapists from Milestone Physiotherapy can assist with both pre-operative and post-operative rehabilitation. We recommend that patients start with physiotherapy before surgery to strengthen the quads and other muscles, providing better control and preparing the body for surgery. Pre-operative rehabilitation allows physios to understand patients' normal knee size, current conditions, hobbies, goals, and capabilities.

At a Milestone Physiotherapy near you, we are guided by the Melbourne protocol for treating ACL injuries. This protocol is structured into several stages, each serving as a threshold that patients must overcome to advance in their rehabilitation process. Here’s a detailed look at the stages:

Stage 1: Initial Recovery

• Goal: Reduce swelling and achieve knee bend of approximately 180 degrees.

• Methods: POLICE principle (Protection, Optimal Loading, Ice, Compression, Elevation) is applied to control inflammation and promote early movement. Gentle exercises are introduced to maintain joint flexibility and muscle activation without stressing the ACL.

Stage 2: Functional Strength and Stability

• Goal: Perform a single-legged squat.

• Methods: Focus on building strength in the quadriceps, hamstrings, and surrounding muscles. Controlled exercises and resistance training are implemented to enhance knee stability and overall leg strength. Balance and proprioception exercises are also introduced to improve coordination and knee control.

Stage 3: Advanced Strengthening and Functional Training

• Goal: Achieve higher levels of functional strength and prepare for return to activity.

• Methods: Progressively challenging exercises that mimic sports or daily activities are added. Plyometric exercises, agility drills, and sport-specific training are incorporated to prepare the knee for dynamic movements.

Stage 4: Return to Activity

• Goal: Safely resume normal activities, including sports.

• Methods: Gradual return to sports and activities with close monitoring to ensure proper technique and prevent re-injury. Ongoing strength and conditioning programs are maintained to support long-term knee health.

Additional Recovery Methods

• Sports Massage: Helps to alleviate muscle tightness and improve blood flow to the injured area.

• Dry Needling: Targets muscle tension and trigger points around the knee, excluding the joint itself, to reduce pain and improve function.

• Active Movement: Encouraged throughout the recovery process to facilitate fluid drainage, reduce swelling, and promote tissue healing.

By adhering to the Melbourne protocol and incorporating comprehensive recovery methods, Milestone Physiotherapy ensures a holistic approach to ACL injury rehabilitation, tailored to the individual needs and goals of each patient. Regular progress evaluations and adjustments to the rehabilitation program ensure that patients remain on track and motivated. Additionally, we emphasise the importance of patient education, empowering individuals with the knowledge and skills to manage their condition and prevent future injuries. Here, we not only aid in physical healing but also support patients in regaining confidence and achieving their full potential.