ACL and Ligament Injuries

 James leaned on his pillow enveloped in a (socially distant) cloud of interns and residents as Dr Azlan Sofian walked up to his hospital bed in Shah Alam Hospital.

Azlan watched as an intern marked out a large arrow in blue permanent ink on James’ right foot.

Then they went through the list of risks and possible 

complications together, James nodding gravely as words like ‘infection’, ‘low risk of injury to vessels and nerves’ floated in the air.

Dr Putra Vatakal, Orthopaedic Surgeon, Malaysia, Kuala Lumpur, Selangor, Quill Orthopaedic Specialist Centre, acl reconstruction, acl tear

Six months before, James had been racing up the football field; not a care in his mind except getting the ball at his feet away from the opposing defender.

Sweat dripped from his face as James zig-zagged his way through the other players. Heart racing, his blood pulsing in his ears, James ran.

The goal was close.

So close. 

This was his chance.He turned and swung his foot to ram the ball forward. A shadow, then blur of movement cut in his side. A crash as two bodies collided.

James felt warm all over, then he was falling to the wet grass.

His ACL had popped.

We probably only think about the Anterior Cruciate Ligament (or ACL) when it tears, though it’s working for us all the time.

The ACL is a tough bundle of fibres that holds the main bones of the knee together and keeps them tight and stable, letting us freely walk, run and jump.

Without it, our knees would wobble while running etc, as James found out.

Despite intensive muscle strengthening and rehab, James’ knee continued to be unstable, preventing him from going back to the sport he lives to play.

Which brings us back to James’ in his hospital bed, getting ready to be wheeled into surgery.


Freshly changed into loose hospital gown, soft blue ‘shower’ cap on his head, James put on a brave face as the ward nurses steered his bed toward the whirring doors of the operation theatre.

The team swiftly gets him on to the OR table, and Azlan and I review his MRI scans. Some minutes later, we have opened up the front of James’ shin and have removed the hamstring tendons, which we will use to form a new ACL for James.

The arthroscope goes in, and we dim the OR lights, ‘swimming’ silently through James’ knee. 

We shave part of his thighbone where the remains of his old, torn ACL cling limply, then bore new tunnels to receive the new ACL.

The small wounds around his knee closed, Stella Wong wraps a hinged brace around it and locks it firmly in place.

Some weeks later, back in Sungai Buloh, Dr Aparajitha Krishnan sees James in her clinic. Her team has been rehabilitating him.

Not all ACL tears require reconstruction. Many do well with rehabilitation and muscle strengthening exercises. But for elite athletes like James, being stable on their knees is not a luxury, but essential to survive in the world of sports.

James’ knees are strong again.

And while it will be some months before James is scoring goals on the field again…the journey to recovery has begun.

Originally written on 11 December 2020 in Shah Alam Hospital, Selangor

Image credits: Amirul Ashraq Husain


Names and some details have been changed to protect patient privacy

The author wishes to express deepest gratitude to Dr Azlan Sofian and the team in Hospital Shah Alam for opening their operating rooms (and their hearts) to the patients of Sungai Buloh while COVID continues to eat into our surgical resources.