Most ACL reconstruction is performed using knee arthroscopy. In this minimally invasive procedure, the surgeon makes several small incisions around the knee joint and inserts a narrow fiber optic scope (called an arthroscope) to examine the condition of the knee. Tiny instruments are used to remove the damaged ligament and replace it with a graft. Tunnels are drilled into your femur (thighbone) and tibia (shinbone) to accurately position the graft, which is then anchored with screws or other fixation devices. 

ACL reconstruction surgery uses an autograft (tissue from your body) or an allograft (tissue from a cadaver) to replace the ligament. The autograft method is typically most successful in patients who want to return to a high-demand, athletic lifestyle. As patients get older, and demands diminish, the success of the allograft procedure increases. Ultimately, it depends on the unique needs of each individual. Different techniques work best in different situations.

Anatomy

The ACL is one of the four major ligaments of the knee. It runs diagonally in the middle of the knee and connects the back of the femur to the front of the tibia. The ACL helps stabilizes the knee joint and keep it from rotating.

ACL tears are one of the most common knee ligament injuries. They range from mild, small tears, to severe tears when the ligament and part of the bone separate from the rest of the bone. Most ACL injuries are complete or near-complete tears. A torn ACL can cause your knee to give way during physical activity.

When is surgery recommended?

ACL tears do not necessarily require surgery. Initial treatment focuses on pain control, restoring range of motion and preventing further injury. It is important to regain motion in the knee as soon as possible to aid in recovery.

The decision for operative or non-operative treatment depends on several factors including a patient’s age, activity level, severity of symptoms and expectations. For older, sedentary patients with a relatively stable knee and little desire to return to high-level sports or fitness routines, non-operative rehabilitation and activity modification may be sufficient. For active patients of almost all ages –   especially young athletes – reconstruction of an ACL tear is highly recommended. Stable knees are critical for safely returning to sports and preventing re-injury or additional injury. ACL reconstruction can also minimize the chance of knee arthritis or instability later in life.

What is the recovery time?

Return to daily and sports activities varies depending on the surgery and your surgeon. Physical therapy is generally started soon after surgery, and an appropriate physical therapy program is critical for the surgery's success. Usually, return to sporting activity is restricted for at least six months. 

FAQs

Can I return to sports after ACL surgery?

Yes. You can return to exercise such as walking or jogging within weeks. Usually, patients should wait from four to six months before returning to cutting or contact sports. 

Do I have to wear a brace?

In some cases, patients wear a knee brace or splint to help protect the graft. 

What type of graft do you use?

ACL reconstruction surgery uses an autograft (tissue from your body) or an allograft (tissue from a cadaver) to replace the ligament. There are advantages and disadvantages to the different graft types. Your surgeon will recommend the best one for your injury.

How long is the scar?

You will have several very small incisions (about the size of a buttonhole) around the knee joint. 

Can you repair the ACL tear?

Although some special ACL injuries in the pediatric population can be repaired, a torn ACL usually can't be successfully sewn back together. Therefore, the ligament is replaced with an autograft (tissue from your body) or an allograft (tissue from a cadaver). This is called reconstruction. There are advantages and disadvantages to the different graft types. Your surgeon will recommend the best one for your injury. 

When can I put weight on the leg?

In most cases, you can put weight on your leg after the first day. As time progresses, you can apply as much weight as feels comfortable, and as directed by your surgeon and therapist. 

How much time off work will the surgery require?

It depends on the type of work you do. Time off can range from a few days, if your job is sedentary, to several weeks or months, if your work involves vigorous cutting or jumping activity. 

What is the success rate?

Modern ACL reconstruction is a highly successful operation, and 90 to 95% of patients return to full regular and sporting activities without complications. 

What if I don't have the surgery?

For older, sedentary patients with a relatively stable knee and little desire to return to high–level sports or fitness routines, non–operative rehabilitation and activity modification may be sufficient. For active patients of almost all ages — especially young athletes – reconstruction of an ACL tear is highly recommended. Stable knees are critical for safely returning to sports and preventing re–injury or additional injury. ACL reconstruction can also minimize the chance of knee arthritis or instability later in life.