ACL Reconstruction

Overview

ACL reconstruction typically involves replacing a torn anterior cruciate ligament with a tissue graft to help restore knee stability. The procedure can be performed with arthroscopic techniques and often includes a structured rehabilitation program to support recovery.

Indications

This procedure may be considered when:

• •Knee instability can persist after an ACL tear, particularly during pivoting or cutting activities
• •Associated injuries can occur, such as meniscus tears or cartilage injury, where surgical management can be part of an overall treatment plan
• •Individuals who generally aim to return to higher-demand sports or occupational activities where instability can pose functional limitations

How It Works

The procedure typically involves several coordinated steps:

• •Includes preoperative assessment and imaging to confirm ACL injury patterns and evaluate associated meniscus or cartilage injury
• •Uses anesthesia, and the knee can be examined for laxity after anesthesia to characterize instability
• •Uses arthroscopy to visualize the joint, and concurrent meniscus or cartilage procedures can be performed when indicated
• •Involves selecting a graft, which may come from the patellar tendon, hamstring tendons, quadriceps tendon, or a donor (allograft), depending on patient factors and surgeon preference
• •Involves preparing the graft and creating bone tunnels or sockets in the femur and tibia to position the graft along the native ACL footprint
• •Involves passing the graft through the tunnels and securing it with fixation devices that can include screws, buttons, or other implants
• •Includes checking graft tension and knee range of motion arthroscopically, and incisions can be closed with dressings applied

Risks

As with any surgical procedure, potential risks include:

• •Infection may occur, including superficial wound infection or deeper joint infection
• •Bleeding or hematoma can occur
• •Blood clots (deep vein thrombosis or pulmonary embolism) may occur
• •Knee stiffness or loss of motion can occur, including arthrofibrosis
• •Persistent pain or swelling may occur, including anterior knee pain depending on graft type
• •Graft stretching or graft failure can occur, which may lead to recurrent instability
• •Meniscus or cartilage problems can persist or may develop over time
• •Nerve or blood vessel injury can occur, although this generally appears uncommon
• •Anesthesia-related complications can occur

Recovery Expectations

Recovery follows a gradual progression:

• •Pain, swelling, and limited motion can often occur in the early postoperative period, and gradual improvement may occur over subsequent weeks
• •Weight-bearing status and bracing can vary by surgical technique and associated procedures, and progression typically depends on individualized protocols
• •Physical therapy can often focus on restoring range of motion early and then building strength and neuromuscular control over time
• •Return to running may often be considered after functional milestones, and timelines can vary across individuals and protocols
• •Return to pivoting sports typically may occur months after surgery, and many programs often reference a timeframe that can extend to 6–12 months depending on recovery and testing
• •Some individuals can experience ongoing symptoms such as stiffness, swelling, or pain, and longer-term monitoring can occur

Alternatives

Depending on individual circumstances, alternatives may include:

• •Nonoperative management may include activity modification, structured physical therapy, and bracing to address instability
• •Rehabilitation without reconstruction can be considered for some individuals, particularly when instability generally remains manageable during desired activities
• •Surgical alternatives can include ACL repair in selected tear patterns, which may be considered in specific circumstances depending on tissue quality and injury type

Sources

• AAOS OrthoInfo - Anterior Cruciate Ligament (ACL) Injuries
• Mayo Clinic - ACL injury (Diagnosis and treatment)
• Cleveland Clinic - ACL Surgery (Anterior Cruciate Ligament Reconstruction)
• MedlinePlus Medical Encyclopedia - ACL reconstruction