Appointments by prior arrangement

ACL Reconstruction by Fellowship-Trained Orthopaedic Surgeon Dr Puah Ken Lee

An anterior cruciate ligament (ACL) tear is one of the most common serious knee injuries, particularly in people who participate in football, basketball, rugby, skiing, badminton and other sports involving cutting, pivoting or sudden changes in direction.

At 360 Orthopaedics, Dr Puah Ken Lee provides comprehensive assessment and arthroscopic ACL reconstruction using modern techniques tailored to each patient’s sporting goals, occupation and lifestyle.

Whether your goal is returning to competitive sport or simply regaining confidence in your knee, treatment is individualised to achieve a stable, functional knee while minimising the risk of future injury.

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What is the ACL?

The anterior cruciate ligament (ACL) is one of the major stabilising ligaments inside the knee.

Its main functions are to:

• Prevent the shinbone (tibia) from sliding forwards
• Control rotational stability
• Maintain knee stability during pivoting movements
• Protect the meniscus and cartilage from secondary injury

When the ACL tears, the knee often feels unstable during twisting or pivoting activities.

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How does an ACL tear occur?

Most ACL injuries are non-contact injuries.

Common mechanisms include:

• Sudden change of direction
• Pivoting while the foot is planted
• Landing awkwardly from a jump
• Sudden deceleration
• Hyperextension injuries
• Direct collision during contact sports

Sports commonly associated with ACL injuries include:

• Football
• Basketball
• Netball
• Rugby
• Skiing
• Tennis
• Badminton
• Martial arts

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Symptoms of an ACL tear

Many patients describe:

• A loud “pop” at the time of injury
• Immediate swelling within several hours
• Knee giving way
• Difficulty continuing sport
• Pain
• Loss of confidence during twisting movements

Some patients are still able to walk after the injury despite having completely torn the ACL.

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How is an ACL tear diagnosed?

Diagnosis begins with a detailed clinical assessment.

Dr Puah performs:

• Careful history taking
• Knee examination
• Ligament stability testing
• Assessment of associated injuries

Investigations may include:

• X-rays
• MRI scan
• Ultrasound assessment of associated soft tissue injuries when appropriate

MRI also helps identify:

• Meniscus tears
• Cartilage injuries
• Bone bruising
• Other ligament injuries

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Do all ACL tears need surgery?

No.

Treatment depends on several factors including:

• Age
• Activity level
• Sporting goals
• Occupation
• Degree of instability
• Associated meniscus injuries
• Cartilage damage

Some patients can successfully return to normal daily activities without surgery after appropriate rehabilitation.

However, surgery is often recommended for:

• Young active individuals
• Competitive athletes
• Patients with recurrent instability
• Patients wishing to return to pivoting sports
• Combined ligament injuries
• Associated repairable meniscus tears

Every patient should receive an individualised recommendation.

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What is ACL reconstruction?

ACL reconstruction is a minimally invasive arthroscopic procedure that replaces the torn ligament with a tendon graft.

Small keyhole incisions are used to reconstruct the ligament while preserving the surrounding structures.

The aim is to restore:

• Knee stability
• Confidence during movement
• Return to sport
• Long-term knee health

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Which graft is best?

There is no single “best” graft for every patient.

Common graft options include:

Hamstring tendon

Advantages:

• Smaller incision
• Less pain at the front of the knee
• Excellent long-term results

Potential disadvantages:

• Mild reduction in hamstring strength in some patients

Patellar tendon

Advantages:

• Excellent fixation
• Well-established long-term results

Potential disadvantages:

• Greater risk of kneeling pain
• Anterior knee discomfort

Quadriceps tendon

Advantages:

• Increasingly popular option
• Large graft size
• Good biomechanical strength

Potential disadvantages:

• May not be suitable for every patient

Dr Puah discusses the advantages and disadvantages of each graft before surgery to determine the most appropriate option.

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What happens during surgery?

ACL reconstruction is usually performed under general anaesthesia.

The procedure typically involves:

1. Arthroscopic assessment of the knee
2. Treatment of associated meniscus or cartilage injuries
3. Preparation of the graft
4. Creation of bone tunnels
5. Placement of the graft
6. Secure fixation
7. Final stability assessment

The operation usually takes between 1.5 and 2 hours depending on associated injuries.

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Recovery after ACL reconstruction

Recovery is a structured rehabilitation process.

Typical milestones include:

First 2 weeks

• Control swelling
• Restore knee extension
• Begin walking
• Early physiotherapy

6 weeks

• Improved walking
• Increasing range of motion
• Strengthening exercises

3 months

• Jogging for selected patients
• Progressive strengthening
• Balance training

6–9 months

• Sport-specific rehabilitation
• Agility training
• Functional testing

9–12 months

Many patients return to pivoting sports after meeting appropriate rehabilitation milestones.

Recovery timelines vary between individuals.

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Why rehabilitation is just as important as surgery

Successful ACL treatment depends on both surgery and rehabilitation.

A structured physiotherapy programme helps:

• Restore strength
• Improve balance
• Reduce reinjury risk
• Improve confidence
• Optimise return to sport

Returning to sport too early increases the risk of graft failure.

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Why choose Dr Puah Ken Lee?

Dr Puah Ken Lee is an orthopaedic surgeon with subspecialty expertise in shoulder, elbow and sports injuries.

Patients choose Dr Puah because of his:

• Fellowship training in sports and shoulder surgery
• Extensive experience in arthroscopic (keyhole) surgery
• Personalised treatment plans
• Evidence-based approach
• Focus on helping patients safely return to sport

Every treatment plan is tailored to the individual patient’s goals rather than adopting a one-size-fits-all approach.

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Frequently Asked Questions

Can an ACL tear heal without surgery?

A complete ACL tear does not usually heal back to its original structure. Some patients can function well without reconstruction if the knee remains stable and their activity demands are lower.

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How long does ACL surgery take?

Most procedures take approximately one to two hours.

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Will I need physiotherapy?

Yes. Physiotherapy is essential for achieving the best possible outcome.

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When can I drive?

This depends on which knee was operated on, your pain control, muscle strength and your ability to perform an emergency stop safely.

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When can I return to sports?

Many patients return between 9 and 12 months after surgery, although this varies depending on rehabilitation progress and functional testing.

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Can the ACL tear again?

Yes. Reinjury can occur, particularly if returning to sport before adequate recovery. Appropriate rehabilitation and return-to-sport testing help reduce this risk.

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Arrange a Consultation

If you have suffered a knee injury, instability or a suspected ACL tear, early assessment can help determine the best treatment plan.

Dr Puah Ken Lee provides comprehensive assessment, advanced arthroscopic treatment and personalised rehabilitation planning to help patients return safely to work, daily activities and sport.

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Dr Puah is regularly invited to teach arthroscopic knee surgery

Book a consultation or contact the clinic via WhatsApp to get started

Book a consultation at 360 Orthopaedics, Mount Elizabeth Novena

ACL tears are common but treatable. Early diagnosis and appropriate management can improve outcomes and prevent long-term problems.
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore specialising in shoulder, elbow and sports injuries at 360 Orthopaedics, Mount Elizabeth Novena. Patients with instability and pain in the knee after a sports injury are encouraged to seek specialist evaluation.