ACL Surgical Options

ACL Reconstruction

Complete ACL tears, called ruptures, normally require ACL Reconstruction surgery followed by several months to a year of rehabilitation. ACL Reconstruction is the most common form of treatment for patients who require the use of a stable knee for athletic sports, walking, or other low-impact activities. Typically, the new ligament material (graft) can be taken from one of the patient's own tendons (autograft), or the graft can be taken from a tendon in the knee of a tissue donor (allograft).You and your doctor will decide which option is best for your particular situation.

ACL Reconstruction is usually performed as an outpatient procedure and rarely requires an overnight stay in the hospital. The entire procedure requires approximately 1-2 hours to complete and is typically performed under general anesthesia, spinal or epidural.

ACL Reconstruction is most often performed arthroscopically. Arthroscopy is a surgical technique that uses long tube-like scopes that are inserted into the body through very small incisions. These scopes display the inside of your knee joint on a monitor, allowing the surgeon to precisely manipulate the surgical instruments.

The ACL Reconstruction procedure creates tunnels in the thigh bone (femur) and the shin bone (tibia) to make a path for the new graft (tendon). One of the most common graft used is the semi-tendonosis/gracilis graft. This graft is taken from a portion of the muscles in the thigh. The graft is passed through specially designed instruments into the tunnels and fixed inside the tunnels. The new graft is fixed inside the tunnels with screws, buttons, pins, or similar devices. Some of those devices are made out of materials that resorb or dissolve with time and are replaced with bone by the body. The graft crosses the joint in the position as the original ACL after it is fixed with these devices. The small incisions are then closed and a knee compression bandage is applied. Some surgeons prefer to use a long leg brace postoperatively.


As you and your doctor may have discussed before surgery, extensive rehabilitation is the key to your recovery from ACL reconstruction. Recovery normally requires five to six months, or until the graft is transformed by soft tissue and the ligament is healed. This can require the better part of one year. If the graft is ruptured or stretched during the recovery, a second surgery may be required.

Your physical therapy for the first three weeks after surgery will be bending and stretching exercises to increase active range of motion, flexibility, and strength in your knee. While your knee may feel tight and slightly painful, it is important to keep your joint moving to promote healing and maintain flexibility.

After the first three to four weeks, your physical therapy will most likely concentrate on resistive type strength building exercises (such as cycling or swimming), which are low impact and less harmful to perform, as directed by your surgeon. Strength building exercises are important not only to recover lost muscle mass due to surgery but also to improve joint stability, reducing stress on the ligaments.

Following surgery you may be using crutches as needed for the first few weeks. Crutches are usually not necessary once the knee is comfortable enough to walk. Your surgeon will evaluate your progress and advise you on when you may discontinue using the crutches.

The results of your ACL Reconstruction are based on your discipline, motivation, and perseverance in performing the physical therapy program. With cooperation and dedication, you have an excellent chance in regaining strength and stability.

Maximum medical improvement should be restored to your knee after two to four months of following your physical therapy treatment plan. Once your doctor clears you, most patients typically return to unrestricted recreational activities.

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This information was prepared in conjunction with a licensed physician and is presented as general information only. Only an orthopedic surgeon can determine what treatment is appropriate. The life of any implant will depend on your weight, age, activity level, and other factors. For more information on risks, warnings, and possible adverse effects, see the Patient Risk Information section found within Always ask your doctor if you have any questions regarding your particular condition or treatment options.