What Is ACL Reconstruction?

ACL reconstruction is a surgical tissue graft replacement of the anterior cruciate ligament, which is located in the knee to restore its function after an injury. The torn ligament can be removed from the knee before the graft is inserted in an arthroscopic procedure. The ACL (Anterior Cruciate Ligament) is important for maintaining the stability of the knee joint, particularly in activities involving weaving or kicking. The knee becomes unstable with a ruptured ACL and the knee joint may become more damaged over the period of time. ACL reconstruction is an elective surgical treatment.

Most ACL injuries happen during sports and fitness activities that can put stress on the knee:

  • Suddenly slowing down and changing direction (cutting)
  • Landing from a jump incorrectly
  • Pivoting with your foot firmly planted
  • Receiving a direct blow to the knee
  • Stopping suddenly

A course of physical therapy may successfully treat an ACL injury for individuals who are relatively inactive, engage in moderate exercise and recreational activities, or play sports that put less stress on the knees. Most people will have general anesthesia right before the surgery. This helps you to remain asleep and pain-free. Other kinds of anesthesia, like regional anesthesia or a block, may also be used for this ACL surgery.

Techniques For ACL Reconstruction

Extra-Articular Reconstruction

During the 1970s and 1980s, the extra-articular procedure was commonly performed for anterior tibial subluxation to eliminate any pivot shift but has lost the favor due to residual instability and the later development of degenerative changes. It has been used in isolation or to augment an intra-articular reconstruction.

Intra-Articular Reconstruction

The preferred choice but it does not fully restore knee kinematics by creating a static restraint and was usually accompanied by connecting the lateral femoral epicondyle to Gerdy’s tubercle with the collagenous restraint lying parallel to the intra-articular course of ACL. This also avoids the problem of a lack of blood supply to the intraarticular reconstructions. Most of these procedures use the iliotibial band or tract connecting the lateral femoral epicondyle to the gerdy tubercle, The optimal attachment point for the extraarticular reconstructions for anterolateral rotatory instability is found to be the Gerdy tubercle. This procedure is also used primarily in conjunction with an intraarticular reconstruction when severe anterior instability is due to injury or late stretching of the secondary stabilizing capsular structures or the lateral side of the knee.


You might have injured your anterior cruciate ligament if you experience the following:

  • Hearing a loud “pop” in the knee and experiencing severe pain afterward
  • Pain and swelling
  • Difficulty walking
  • Loss of full range of movement
  • Difficulty straightening the knee

An ACL tear is one of the most common knee injuries, especially among people who participate in high-impact sports like:

  • Basketball
  • Football
  • Soccer
  • Skiing
  • Hockey

Choosing Tissue For ACL Surgery

The tissue to replace your damaged ACL will be collected from your body or from a donor. The tissue collected from your own body is called an Autograft. The two most common places to take tissue from are the knee cap tendon and the hamstring tendon. The hamstring is the muscle behind the knee. The tissue taken from the donor is called an Allograft.

Procedure of ACL Surgery

The procedure can be performed usually with the help of knee arthroscopy. During surgery, a small incision is made in the front of the knee for an arthroscope — a thin tube outfitted with a fiber-optic camera and surgical tools. This allows your surgeon to see inside your knee during the procedure. The camera is connected to a video monitor in the operating room. The surgeon will use the camera to check the ligaments and other tissues of your knee.

The surgeon will first remove your torn ACL and clean the area. They will then drill small holes into your tibia and femur so the bone plugs can be attached with posts, screws, staples, or washers. Also, the surgeon will fix the other damage which is found, and then he will replace the ACL by following these steps:

  • The torn ligament will be removed with a shaver or other instruments.
  • Tissue is being used to make the new ACL, then the surgeon will make a larger cut. Autograft is removed through this cut.
  • The surgeon will attach the new ligament to the bone with the screws or to the other devices to hold it in a place.

At the end of the surgery, the surgeon will close the cuts with the sutures (stitches) and cover the area with a dressing. You may be able to view pictures after the procedure of what the doctor saw and what was done during the surgery.

Risks involved in in ACL Surgery

All surgeries have a certain risk such as:
  • Pain
  • Bleeding
  • Infection in the surgical wound
  • Unsightly scarring
  • Blood clots
  • Difficulty passing urine
Knee surgeries have the risks of:

There is a possibility of getting an allergic reaction to the tracer. People who are highly allergic to iodine, aspartame and saccharin need to talk to their doctor. Some of the health conditions include:

  • Break of the kneecap
  • Damage to nerves around the knee
  • Infection in the knee joint
  • Discomfort in the front of the knee
  • Loss of knee movement
  • Recurrent giving way of the knee
  • Severe pain, stiffness, and loss of use of the knee (Complex Regional Pain Syndrome)


Most people might have a stable knee that will not give away after the ACL reconstruction. Better surgical methods and rehabilitation have led to:

  • Less pain and stiffness after surgery
  • Fewer complications with the surgery itself
  • Faster recovery time.
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Frequently Asked Questions

1. Is ACL reconstruction a major surgery?

ACL surgery is a major surgery that reconstructs or replaces a torn anterior cruciate ligament (ACL) in your knee. Your doctor may only consider ACL surgery for you if it suits your needs and lifestyle.

2. Can I walk after ACL reconstruction?

Patients walk unassisted within 2-4 weeks, but for short periods. After 10-12 weeks, expect brisk walking, light jogging, and even plyometric exercise. Full recovery on ACL reconstruction is 6-12 months or more with physical therapy.

3. How long is an ACL surgery recovery?

An average recovery takes about six months, but it can take longer. If you are an athlete, your doctor may recommend a sports-specific rehab program.

4. Can ACL surgery fail?

ACL surgery can fail, even in the best of circumstances. It is generally felt that a well-done ACL reconstruction has about a 5% chance of failure due to trauma. The most common cause of an ACL graft failure is a technical error with malposition of the original ACL reconstruction tunnels.