ACL surgery is the gold standard treatment for complete ligament tears causing knee instability.

Anterior Cruciate Ligament (ACL) injury is one of the most common knee ligament injuries, especially among athletes and physically active individuals. A partial or complete ACL tear can lead to knee instability, pain, swelling, and difficulty in walking or playing sports.

ACL surgery, also called ACL reconstruction, is performed to replace the torn ligament with a tissue graft, restoring knee stability, strength, and function. It is usually recommended when the ligament is completely torn or when patients want to return to high-activity sports.

What is ACL Surgery?

ACL surgery is a minimally invasive arthroscopic procedure in which the damaged ligament is reconstructed using a graft taken from:

  • Hamstring tendon

  • Patellar tendon

  • Quadriceps tendon

  • Donor tissue (allograft)

The new graft acts like a natural ACL and gradually integrates with the knee joint over time.

When Do You Need ACL Surgery?

Surgery is generally advised in the following cases:

  • Complete ACL tear

  • Knee instability while walking or running

  • Athletes involved in pivoting sports

  • Associated meniscus injury

  • Failure of physiotherapy or conservative treatment

  • Recurrent knee giving-way episodes

Partial tears in low-activity individuals may sometimes be managed without surgery.

Ideal Timing for ACL Surgery

Most orthopedic surgeons recommend surgery within 3–6 weeks after injury once:

  • Swelling reduces

  • Knee movement improves

  • Muscles regain basic strength

Delaying surgery beyond 3 months may increase the risk of cartilage or meniscus damage due to persistent instability.

Types of ACL Surgery

1. ACL Reconstruction (Standard Procedure)

  • Torn ligament replaced with graft

  • Highest success rate

  • Gold standard treatment

2. ACL Repair

  • Torn ligament stitched back

  • Limited indications

  • Higher failure rates than reconstruction

3. BEAR Procedure (Bridge-Enhanced ACL Repair)

  • Newer technique using bio-implant

  • Still under long-term research evaluation

Step-by-Step ACL Reconstruction Procedure

  1. Small incisions made around the knee

  2. Arthroscope inserted for internal visualization

  3. Torn ACL removed

  4. Graft harvested or donor graft prepared

  5. Bone tunnels created

  6. Graft fixed with screws or implants

  7. Stability tested before closure

The procedure is usually day-care surgery.

Recovery Timeline After ACL Surgery

Recovery Phase

Timeline

Walking with support

Same day / 1–2 days

Physiotherapy start

2–3 days

Running

3–5 months

Pivot sports drills

5–8 months

Return to sports

9–12 months

Most patients return to sports within 9–12 months after surgery.

Rehabilitation After ACL Surgery

Structured physiotherapy is essential and includes:

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  • Range-of-motion exercises

  • Quadriceps strengthening

  • Balance training

  • Proprioception drills

  • Sport-specific rehab

Supervised rehab reduces re-injury risk and improves long-term outcomes.

ACL Surgery in Teenagers & Children

ACL reconstruction is possible in adolescents, but special care is taken to protect growth plates. Pediatric techniques include:

  • All-inside epiphyseal reconstruction

  • Iliotibial band graft procedures

These allow safe return to sports without affecting bone growth.

Success Rate of ACL Surgery

ACL reconstruction has a success rate of 85–95% when performed by experienced orthopedic surgeons with proper rehabilitation.

Most patients regain:

  • Knee stability

  • Sports participation ability

  • Normal daily activity function

Risks & Complications

Though uncommon, potential risks include:

  • Infection

  • Graft failure

  • Knee stiffness (arthrofibrosis)

  • Blood clots

  • Re-tear injury

Early rehab and follow-ups minimize complications.

Long-Term Outlook

Modern ACL grafts are durable, and with proper rehab:

 

  • Athletes return to competitive sports

  • Knee function remains stable

  • Osteoarthritis risk reduces compared to untreated tears

FAQs – ACL Surgery

1️⃣ What is ACL surgery?

ACL surgery is a minimally invasive arthroscopic procedure in which the torn anterior cruciate ligament is reconstructed using a tendon graft to restore knee stability and function.

2️⃣ When is ACL surgery required?

ACL surgery is required in complete ligament tears, knee instability, sports injuries, meniscus damage, or when conservative treatment fails to restore knee function.

3️⃣ What is the recovery time after ACL surgery?

Initial recovery takes 4–6 weeks, but full return to sports may take 9–12 months depending on rehabilitation and muscle strength recovery.

4️⃣ Is ACL surgery painful?

Pain is manageable with medications and physiotherapy. Modern minimally invasive techniques reduce post-operative pain and speed up recovery.

5️⃣ What is the success rate of ACL reconstruction?

ACL reconstruction has a success rate of around 85%–95% when performed by experienced orthopedic surgeons with proper rehabilitation.

6️⃣ Can athletes return to sports after ACL surgery?

 

Yes, most athletes can return to competitive sports after 9–12 months following structured physiotherapy and strength training.