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ACL Surgery in Singapore
The anterior cruciate ligament (ACL) is a critical ligament located within the knee joint, integral to maintaining stability. This ligament connects the femur (thigh bone) to the tibia (shin bone) and is key in coordinating smooth, controlled movements of the knee, and by extension, the entire leg.
- Are your knee pain symptoms affecting your quality of life? Consult our MOH-accredited ACL specialist for a comprehensive diagnosis of your condition & a personalised treatment plan.
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
Prevalence of ACL Injuries in Singapore
ACL injuries are a common occurrence among the athletic population in Singapore, particularly in sports involving sudden changes in direction, jumping, and rapid deceleration. Though comprehensive statistics on the prevalence may fluctuate annually, these injuries are recognized as a concern for both professional and amateur athletes.
Indications for ACL Surgery
Surgery for ACL reconstruction is indicated when there is a complete tear of the ligament or when the injury leads to knee instability that affects the patient’s quality of life or hinders performance in sports or other activities.
ACL surgery is recommended when conservative treatments such as physiotherapy and bracing have not improved knee stability. Furthermore, individuals who have a high activity level or are involved in pivoting sports are potential candidates for this surgery to prevent secondary knee damage and to facilitate a return to their previous levels of activity.
Pre-Surgical Assessment
Initial Consultation: What to Expect
During the initial consultation, patients can anticipate a thorough medical history evaluation and a physical examination focusing on the knee. The orthopaedic surgeon will assess the extent of the injury, range of motion, and any associated discomfort. This visit serves to discuss the surgical plan, potential risks, and expected outcomes.
Diagnostic Procedures for ACL Injury
Diagnosis of an ACL injury typically involves a combination of clinical assessment and imaging studies. The Lachman test, a physical examination manoeuvre, is commonly performed to evaluate ACL integrity. Imaging modalities include:
- X-rays: To rule out bone fractures.
- Magnetic Resonance Imaging (MRI): Offers detailed images of soft tissue, confirming the ACL tear and assessing concurrent injuries.
- Ultrasound: Occasionally used to visualise the soft tissue structures.
Preparing for ACL Surgery: Patient Guidelines
Patients scheduled for ACL surgery should adhere to specific guidelines to ensure optimal surgical outcomes:
- Medical Clearance - Undergo a preoperative medical assessment to identify any conditions that may complicate surgery.
- Medication Review - Inform the surgeon of all medications taken, as some may need to be paused, especially blood thinners.
- Fasting - Patients will be instructed to fast, typically from midnight on the day of surgery.
- Physical Preparation - Engage in prescribed pre-surgical exercises to strengthen the leg muscles, aiding in postoperative recovery.
- Arranging Support - Plan for post-surgery assistance with activities and transportation, as driving will not be possible immediately after the procedure.
- Postoperative Plan - Understand the post-surgery rehabilitation plan and commit to the necessary follow-up appointments and exercises.
Surgical Options for ACL Reconstruction
ACL reconstruction surgery is tailored to the individual’s needs, activity level, and specific injury characteristics. The goal is to restore knee stability and function. The surgical options for ACL reconstruction generally include:
- Patellar Tendon Autograft: Uses a strip of tendon from the patient’s own knee, incorporating bone from the patella (knee cap) and tibia (shin bone).
- Hamstring Tendon Autograft: Harvests tendons from the patient’s hamstring to create a new ACL.
- Quadriceps Tendon Autograft: Involves a section of tendon from above the kneecap.
- Allograft: Utilises donor tissue, often reserved for revision surgeries or when patient tissue is not suitable.
The surgeon determines the most appropriate graft based on the patient’s age, activity level, and graft availability. Each graft type has its advantages and potential drawbacks, influencing the decision-making process.
The procedure typically involves arthroscopy, where small incisions are made, and the surgery is performed with the aid of a camera and specialised instruments. This minimally invasive approach reduces recovery time and postoperative pain.
The ACL Surgical Procedure
ACL reconstruction is a surgical procedure that replaces the damaged ACL with a graft to restore knee stability and function.
The procedure typically follows these steps:
Anaesthesia |
Administered to ensure patient comfort during the surgery. Options include general anaesthesia, regional anaesthesia, or a combination. |
Arthroscopic Evaluation |
An arthroscope, a small camera, is inserted through a small incision to provide a clear view of the knee joint. |
Graft Harvesting |
If an autograft is used, a tendon is harvested from the patient’s body, while allografts are prepared for implantation. |
Tunnel Preparation |
Drilling of bone tunnels in the tibia and femur where the graft will be placed to replicate the ACL’s natural course. |
Graft Placement |
The graft is threaded into place through the prepared tunnels. |
Graft Fixation |
The graft is secured with screws or other fixation devices to hold it within the bone tunnels. |
Closure |
The incisions are sutured, and a dressing is applied. |
Immediate Postoperative Care |
Monitoring in a recovery area as anaesthesia wears off, followed by initial postoperative instructions. |
Duration |
The procedure duration varies but typically takes one to two hours. The patient usually returns home on the same day. |
Post-Surgical Care and Recovery
Post-surgical care is critical for optimal recovery from ACL reconstruction. This phase is characterised by several components:
- Initial Recovery: In the immediate aftermath of surgery, patients will stay in a recovery room as the effects of anaesthesia diminish. Pain management begins, often utilising multimodal strategies.
- Pain Management: Appropriate analgesia is provided to manage pain. This may include medications and ice therapy to control swelling.
- Mobilisation: Early movement is encouraged to promote circulation. Weight-bearing status is dictated by the surgical technique and graft choice.
- Bracing: The knee may be immobilised initially with a brace to protect the graft.
- Physical Therapy: Begins within a few days to weeks post-surgery, focusing on restoring range of motion, strength, and eventually, functional movements.
- Home Care Instructions: Patients receive detailed guidance on wound care, signs of complications to monitor, and contact information for concerns.
- Follow-Up Appointments: Regular appointments are scheduled to monitor progress and adjust the recovery plan as needed.<
- Physical Therapy: Minimise activities that can cause repetitive knee stress. Take breaks to stretch and move, especially when standing or sitting for long periods.
Recovery timelines vary but typically include several months of physical therapy. Return to sport or full activity is a gradual process, with milestones set by the orthopaedic surgeon and physical therapist based on individual progress.
Risks and Complications Associated with ACL Surgery
Common Surgical Risks and How They Are Managed
ACL surgery, like all surgical procedures, carries inherent risks which include:
- Infection: Managed with sterile techniques during surgery and prophylactic antibiotics.
- Bleeding: Minimised through careful surgical technique and coagulation management.
- Blood Clots: Risk reduced with early mobilisation and, if indicated, anticoagulant medication.
- Graft Failure: Patient education on activity restrictions and adherence to rehabilitation can reduce this risk.
- Stiffness or Loss of Range of Motion: Mitigated through physical therapy.
- Nerve or Vascular Injury: Infrequent and minimised with the use of meticulous surgical techniques.
Recognising Signs of Potential Complications
There are several symptoms that may indicate complications:
- Increased Redness, Swelling, or Warmth: Potential signs of infection.
- Excessive Pain: Unrelieved by prescribed medication might suggest infection or other issues.
- Calf Pain or Swelling: May signal a blood clot and requires immediate attention.
- Fever: A temperature over 38°C could indicate infection.
- Unusual Drainage: Any unexpected fluid from the surgical site should be evaluated
Schedule An Appointment With Us
Are Your Symptoms Affecting Your Quality Of Life?
Consult our MOH-accredited ACL specialist for a comprehensive diagnosis of your condition & a personalised treatment plan.
Success Rates and Outcomes of ACL Surgery in Singapore
ACL reconstruction surgery in Singapore has a high success rate, with outcomes generally favourable. Success is measured by the restoration of knee stability, return to pre-injury levels of activity, and patient satisfaction. Long-term outcomes also include the prevention of secondary knee injuries, such as meniscal tears or early-onset osteoarthritis.
Cost Of ACL Surgery In Singapore
- Surgical Fees: The surgeon’s fee will typically depend on their experience and the complexity of the procedure.
- Hospital Charges: Costs for the use of the hospital facilities, including the operating theatre, recovery room, and any hospital stay.
- Anaesthesia Fees: Charged by the anaesthetist for providing services before, during, and after the procedure.
- Medication and Supplies: This includes the cost of all medications, surgical supplies, and post-surgery necessities like braces and crutches.
- Physiotherapy: Post-operative rehabilitation costs, which can vary depending on the duration and intensity of the prescribed therapy.
- Follow-up Care: Charges for post-operative visits and any additional treatments or interventions that may be required.
Dr Poh Seng Yew
MBBS
MRCSEd
MMED (Ortho)
FRCSEd
With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.
- Former Director of Sports Service, Department of Orthopaedic Surgery, Singapore General Hospital
- Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany
- Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
- Master of Medicine (Orthopaedic Surgery), National University of Singapore
- Member, Royal College of Surgeons of Edinburgh (MRCSEd)
- Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
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Your symptoms shouldn’t affect your quality of life or disrupt daily activities. Reach out to our friendly clinic staff today & schedule a consultation.
Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
Frequently Asked Questions
What is the typical recovery time for ACL surgery?
Recovery time varies but typically spans 6 to 9 months until full activity can be resumed, with ongoing improvements up to a year.
Are there any age or activity level restrictions for undergoing ACL surgery?
Surgery is generally recommended based on activity level and knee stability rather than age. Suitability is assessed on a case-by-case basis.
Can ACL surgery be repeated if a graft fails or another injury occurs?
Revision surgery is possible and is determined by individual patient circumstances and overall knee health.
Is ACL surgery covered by health insurance in Singapore?
Coverage depends on the individual’s health insurance policy. Patients should verify with their insurance provider.
What measures are taken to ensure the safety and quality of ACL surgery in Singapore?
Measures include adherence to international surgical standards, mandatory accreditation for facilities, and continuous surgeon training.