What is an ACL tear? An ACL tear is one of the most frequently occurring knee injuries that people can get. I am a proficient sports surgeon(orthopedic) who has treated a wide range of athletes. Based on what I have experienced over the years, I will be talking about the most important things you need to know about ACL tears in this article. I will also be talking about your treatment for ACL tears in Singapore. The aim is to provide an informed source that will help you make the right choices when it comes to treating ACL tears in Singapore.
What is an ACL tear Singapore?
ACL is the acronym for Anterior Cruciate Ligament. It is one of the main ligaments in the knee region because, by virtue of its position(it is located in the middle of the knee), it connects the femur(thigh bone) to the tibia(shin bone). It essentially prevents the shin bone from sliding forward and spinning out of control.
Torn ACLs increase the risks of a knee injury during movements that require a sudden change in direction. This is why it is important that you have a healthy ACL if you play sports.
How can you tell if your ACL is torn?
Most ACL tears occur while changing directions in a sports game, for instance. If you pay close attention, there is a ‘pop’ sensation that you will experience. The swelling of the knee will most likely follow because of the bleeding of the torn ligament.
One major sign that suggests that you have a torn ligament is that you will immediately be unable to walk or continue whatever activity you were involved in due to the pain. Your knee will also feel unstable even after the swelling in your knee subsides.
During my examinations of the patient’s knees, I use a series of tests to examine the stability and ACL function. An MRI scan is then conducted to verify if the patient has an ACL tear or is perhaps harboring some other knee injury.
Which famous athletes have had an ACL Tear?
Lots of professional athletes have been troubled by ACL tears. Some of the more famous ones are:
Zlatan Ibrahimović, Swedish professional footballer
Ruud Van Nistelrooy , Dutch footballer (retired)
Paul Gascoigne (Gazza) – English former professional football player & manager
Alan Shearer – English footballer (retired)
Tom Brady – American football quarterback
Tiger Woods – American professional golfer
Jamal Crawford – American professional basketball player
Derrick Rose -American professional basketball player
So if you have an ACL tear, understand that it’s no big deal since it can happen to anyone. Even the rich and famous.
The good news is that the chances of full recovery from ACL tears are high. Athletes who have had this injury have been able to continue with their playing careers after having ACL reconstruction.
Can a torn ACL heal on its own?
No. ACLs do not usually heal well on their own because your knee is always moving. The exception is when the tear is a partial one. With a partial ACL tear, you may be able to avoid surgery, especially if you are involved in activities that do not involve sudden changes in direction.
Is ACL reconstruction surgery the only treatment option for an ACL tear?
ACL reconstruction is a procedure wherein the torn ligament is completely substituted by a replacement tissue known as a graft. This reconstruction affords the knee great stability and is often the best treatment for athletes who are temporarily unable to play sports because of an ACL tear.
In my opinion, it’s always best to consult an experienced physiotherapist for rehab before undergoing. The reason for this is that it allows your knee to regain movement and strength.
My patients also have the option of a treatment which I call an ACL repair. With ACL repair, the ends of the torn ACL are reconnected to the thigh bone with an internal brace. However, this treatment is not the best option for some ACL tears.
Then there are various experimental studies on the use of stem cell and platelet-rich plasma in ACL healing. These studies might metamorphose into cutting edge technologies in the future, but at the moment, they are still experimental. So at the moment, ACL reconstruction surgery is still considered as the best treatment for ACL tears.
How much does an ACL surgery cost in Singapore?
Here’s a view of what it will cost you to get an ACL Reconstruction
|Public Hospitals (Subsidized)||$502 – $1,200|
|Private Hospitals||$17,000 – $21,000|
Patients can get up to $3,950 in subsidies from public hospitals. An ACL reconstruction at these hospitals will cost around $1,000 after subsidy.
For private hospitals, ACL reconstruction costs between $17,000 – $21,000. However, with some private hospitals, patients are eligible for cashless treatment that does not require admission or discharge charges. These conditions only apply if they have an Integrated Shield Plan and a full rider. The costs of the surgery are affected by the type of bed, length of stay, cost of materials, and the type of implants.
Breakdown of cost for ACL reconstruction surgery at private hospitals
|Surgeon Fees||$8,560 – $13,000|
|Anesthetist Fees||$1,605 – $2,100|
|Facility Fees||$4,300 – $6,800|
It is much cheaper to get ACL reconstruction done at public hospitals, but it might take a while (several months). With private hospitals, patients can have surgery done within the week.
One other issue with public hospitals is that non-specialists are often conscripted for specialist cases. To avoid this scenario, patients have to pay extra to be upgraded to private specialist-only care. In addition, the subsidized B2/C class wards are not very comfortable as there is no air-conditioning, and the cubicles are often full of beds.
Who will benefit most from an ACL reconstruction surgery?
Based on my experience, these types of patients benefit the most:
- Active adults who are involved in sports that require pivoting or turning like soccer and basketball (among others).
- An active adult whose jobs require pivoting or turning
- Older adults (say above 50) who still play sports.
- Children or adolescents with ACL tears
- Athletes with other knee injuries that involve the PCL (posterior cruciate ligament), LCL (lateral collateral ligament), menisci, and cartilage.
- Patients with meniscus tears.
When is the best time to go for an ACL reconstruction surgery after an injury?
I would advise patients to get an ACL reconstruction surgery within a few weeks of the injury. This is because delaying the surgery for more than six months increases the risk of injury to other structures in the knee (cartilage and menisci).
What happens during an ACL reconstruction surgery?
Here is a timeline of a regular ACL reconstruction surgery:
- Administration of anesthesia
- Two small keyhole incisions are made at the front of the knee. Another small one is made on the inside to harvest your hamstrings and to replace your ACL. It is a minimally invasive procedure.
- I thoroughly inspect the knee with a telescope, after which I drill small channels in the thigh bone and shin bone where the ACL sits.
- The placement of these tunnels is important to achieve a good result.
- I’ll then pass the hamstring graft through the tunnels and secure it with a metal button and plastic screw.
- You’ll be able to walk the same day after surgery with crutches.
- In the UK and Australia, where I trained, most patients can go home on the same day of surgery.
Who can perform an ACL reconstruction surgery in Singapore?
An ACL surgery can be performed by any certified orthopedic surgeon who has the required training and is sufficiently experienced. However, it is in your best interest to have your surgery done by a dedicated Sports Surgeon.
What are the advantages and disadvantages of going for ACL reconstruction surgery?
- Strong knees
- Continued engagement in sports and other activities
- Reduced risk of premature arthritis
- Healthier results, especially when other damaged structures (like menisci) are treated at the same time.
- Extended recovery period and rehabilitation
- High costs and surgery-related risks
How much improvement can you expect after an ACL reconstruction surgery?
Having an ACL reconstruction won’t give you superpowers, although it will increase your chances of getting back to your best again.
What is the recovery process and downtime like after an ACL reconstruction surgery?
- Patients are given some strong painkillers to minimize pain post-procedure.
- Patients are able to walk right after the surgery(they have to use crutches though)
- In some cases, patients may be able to go home the same day
- Physiotherapy should be started after the operation. It should continue for 6-9 months
- Patients may be on crutches for up to 6 weeks
- Patients can start driving at about 4-6 weeks
- Patients can return to office-based work after two weeks
For those with more physically demanding jobs, it might take longer to return to work.
It will take athletes between 6 – 12 months, but that depends on the individual recovery period. Returning to strenuous activities too soon increases the risks of the ACL graft tear, so it is vital that patients heed the physiotherapist’s advice.
If you return to sport too soon, you have an increased risk of your ACL graft re-tearing. It’s important to follow your physiotherapist’s instructions carefully.
How to get the best results after an ACL reconstruction surgery?
Start moving around as soon as possible after surgery. Be mindful of the level of pain, though. Work with your physiotherapist as much as possible. This should help get your knee straight, reduce the swelling, and get your front thigh muscles working again.
Once you are discharged from the hospital, continue with physiotherapy. Try to undergo a rehab program over the next 6-12 months. This will help you recover your leg balance, strength, and agility. After this program, you can then progress to running, pivoting, and finally playing sports or whatever activity you enjoy doing.
It’s important that you ease yourself in gradually because it will take time to rebuild fitness and skill levels (if you play sports). Warm-up and cooling off exercises are also very important too. You might also want to try neuromuscular training programs because they reduce the risk of an ACL tear.
Will you still experience pain after the ACL reconstruction surgery?
It depends. It is always advisable to use strong painkillers to minimize post-surgery pain. Most patients stop taking painkillers after a week or so because they no longer feel the pain and shock associated with the injury.
What are the complications following ACL reconstruction?
Some of the post-surgery complications may include:
- Temporary pain, swelling, and stiffness –It improves over time with the help of painkillers and physiotherapy.
- Infection – The risk of this is around 0.37% because patients are given antibiotics at the time of surgery—the small incisions also minimize the risk of infection.
- ACL graft re-tear – About 6% of patients may experience graft re-tear after a while( 5 years) if there is a repeat injury to the knee.
Am I able to continue doing sports after an ACL reconstruction surgery?
Yes. You might even be able to your pre-injury level of fitness.
How can you find the best orthopedic surgeon in Singapore for ACL reconstruction?
The best surgeon should be one listens, is empathetic, and is experienced. Better yet, they might be familiar with the demands on your knee(s). It is even better if they are into sports too because they will be able to appreciate your thought process and concerns.
What questions about my ACL treatment should I ask my doctor?
- Are you a dedicated sports surgeon?
- Do you understand the demands of my sports/activity?
- What is your preferred graft choice, and why?
- What method do you use and why?
- What are the hazards of ACL reconstruction?
- What kind of recuperation program does your physiotherapist use, and why?
- When will I be able to get back to work?
- When can I engage in sports again?
ACL tears are no longer career-ending injuries because the right surgical techniques and proper rehabilitation can correct them. Getting an ACL reconstruction is your best bet if you have issues with your ACL. If you’re looking for a good orthopaedic surgeon to treat sports injuries such as ACL tears and repairs, check out our recommended list of the Best Sports Doctors in Singapore.