Explore ACL injury causes, surgical options, recovery process, and more. Understand your knee health with expert insights.

Anterior cruciate ligament (ACL) reconstruction is a specialized orthopedic procedure that helps restore the normal knee function and knee stability after an injury. This is particularly useful for physically active individuals and athletes. 

In this surgery, the torn ligament is replaced with a healthy ligament for full recovery. The process has become more precise with advances in arthroscopic surgery, careful use of anaesthesia and customized exercises. Patients get better long-term outcomes and the post-surgery recovery time is also reduced.

In this blog, we explore what ACL reconstruction involves, who it's for, how the surgery is performed, and what recovery looks like.

Understanding ACL Injuries and Your Knee Anatomy

To understand ACL injuries and their impact, it helps to first become familiar with basic knee anatomy and the role of the anterior cruciate ligament (ACL). This key ligament is essential for knee stability, especially during dynamic movements like jumping, pivoting, or sudden stops.

What is the Anterior Cruciate Ligament (ACL)?

The anterior cruciate ligament (ACL) is one of the major stabilizing ligaments in the knee joint. It connects the thighbone (femur) to the shinbone (tibia) and plays a vital role in maintaining knee stability during activities that involve sudden changes in direction, jumping, or abrupt stops.

How Do ACL Injuries Occur?

ACL injuries most commonly occur during sports or physical activity. They happen when the knee is suddenly twisted or forced into an unnatural position, such as during rapid deceleration, pivoting, or landing awkwardly. ACL injuries are frequently seen in sports like football, basketball, skiing, and gymnastics.

Common Causes of ACL Tears

An ACL tear can result from several high-risk movements, including:

• Sudden changes in direction

• Landing awkwardly from a jump

• Direct impact to the knee

• Abrupt stopping while running

Overuse, weakened ligaments, or poor neuromuscular control can also increase the risk of ACL tears, leading to significant knee instability and discomfort.

Symptoms of an ACL Injury

A torn ACL is often immediately noticeable. Common symptoms include:

• A loud "pop" sound at the time of injury

• Sudden and intense knee pain

• Swelling in the knee within hours

• Knee stiffness and limited range of motion

• A feeling of instability or the knee "giving out" when bearing weight

Deciding on ACL Surgery

If you're considering ACL reconstruction, understanding when and why the procedure is recommended can help you make an informed decision. Here's what you need to know:

When is ACL Surgery Recommended?

ACL surgery is typically recommended for individuals with a complete ligament tear who experience knee instability during daily activities. It is also commonly advised for athletes who require full knee function to return to sports safely and effectively.

Factors Influencing the Decision to Have Surgery

Several factors can influence the decision to undergo ACL reconstruction surgery, including:

• Age of the patient

• Level of physical activity

• Severity of the ACL tear

• Presence of associated damage (such as meniscus injury)

Young, active individuals are often the most likely candidates to benefit from surgical intervention.

Surgical vs. Non-Surgical Treatment Options

Not all ACL injuries require surgery. In mild cases or partial tears, non-surgical treatments such as physiotherapy, activity modification, and bracing may be effective. However, in more severe cases, especially where knee stability is compromised, ACL reconstruction is usually the preferred option to restore full function and prevent future complications like osteoarthritis.

The Importance of Timely Surgery

Delaying ACL surgery can lead to further joint damage or secondary ligament injuries. Early intervention improves the chances of a successful recovery, helps restore knee function, and reduces the risk of long-term issues.

Preparing for ACL Surgery

Proper preparation before ACL reconstruction surgery is essential for a successful outcome. Here’s what patients can expect before the procedure begins:

Pre-Operative Physical Therapy and Exercises

Before surgery, patients have to undergo physiotherapy because it focuses on strengthening the surrounding muscles and reducing knee stiffness and swelling. This improves surgical results.

Restoring Full Range of Motion Before Surgery

Achieving a full range of motion prevents any post-surgery complications, ensures smoother recovery and makes it easy to execute rehabilitation exercises afterward.

What to Expect Before the Procedure

Patients take a pre-op evaluation that involves physical exams and imaging. This is when the surgeon discusses anesthesia for ACL surgery and graft options and sets recovery expectations.

ACL Reconstruction Surgery Explained

If you're considering ACL reconstruction surgery, understanding how the procedure works can help you feel more prepared. Here’s a detailed overview of what to expect:

How ACL Reconstruction Works

During ACL reconstruction, the surgeon removes the damaged ligament and replaces it with a graft. This graft may be taken from the patient’s own body (autograft) or from a donor (allograft). The new graft helps restore knee stability and function.

Types of Grafts Used in ACL Surgery

There are three common graft options used in ACL surgery:

• Patellar tendon grafts: Often preferred by athletes for their strength and durability.

• Hamstring tendon grafts: Known for causing less post-operative pain and offering greater flexibility.

• Allografts: Donor tissue used in revision surgeries or for specific cases such as pediatric ACL reconstruction.

Minimally Invasive Arthroscopic Techniques

Modern ACL reconstruction is typically performed using minimally invasive arthroscopic techniques. These approaches result in smaller incisions, reduced scarring, and faster recovery times compared to traditional open surgery.

Anesthesia Options for ACL Surgery

Patients can undergo ACL surgery under general anesthesia or regional anesthesia (such as spinal or nerve blocks). The choice depends on the patient’s health status, personal preferences, and the complexity of the procedure. Your surgical team will help determine the safest and most effective option for you.

ACL Reconstruction vs. ACL Repair

Understanding the difference between ACL reconstruction and ACL repair can help patients choose the most suitable treatment approach based on the extent of their injury.

Understanding ACL Reconstruction

ACL reconstruction is the most commonly performed procedure for complete ACL tears. It involves removing the torn ligament and replacing it with a graft, typically harvested from the patient’s own tissue or from a donor. This method provides long-term knee stability and is especially beneficial for active individuals and athletes.

Modern ACL Repair Techniques

In cases of partial ACL tears, advanced ACL repair techniques, such as bridge-enhanced ACL repair (BEAR), can be used to preserve the native ligament. These procedures utilize scaffolds or biologic implants to support natural healing and ligament regeneration.

Considerations for ACL Revision Surgery

ACL revision surgery is necessary when a previous reconstruction fails or the patient experiences a new injury. It is a more complex procedure that involves selecting new graft materials, evaluating knee structure, and addressing any damage caused by the initial surgery or reinjury.

ACL Surgery for Pediatric Patients

ACL surgery in children and adolescents requires a different approach than in adults due to their ongoing growth and development.

Unique Considerations for Growing Children and Adolescents

In pediatric ACL injuries, preserving the growth plates is essential. Surgeons plan the procedure with great care to avoid disrupting normal bone growth and ensure long-term joint function.

Innovations in Pediatric ACL Surgery Techniques

Advancements in pediatric ACL surgery allow for safer techniques that accommodate growing bones. Modern methods minimize the risk of growth disturbances while providing effective ligament repair or reconstruction.

Post-Surgery Rehabilitation for Younger Patients

Rehabilitation programs for children are customized to their age and physical development. These plans focus on gradual recovery, supervised physical therapy, and injury prevention strategies to reduce the risk of re-injury during the healing process.

Recovery After ACL Surgery

Recovering after ACL surgery requires a structured rehabilitation plan and careful post-operative care to ensure optimal knee function and stability.

Immediate Post-Operative Care

In the first few days after ACL reconstruction, patients are monitored closely for knee pain, swelling, and limited mobility. Cold therapy, compression, bracing, and gentle range-of-motion exercises are used to control inflammation and protect the surgical site.

The Rehabilitation Process: Stages and Exercises

ACL surgery recovery is typically divided into phases. Early stages focus on restoring range of motion and reducing swelling, followed by progressive strengthening exercises. Later stages involve balance training, functional movement, and sport-specific rehabilitation to prepare for a safe return to activity.

Expected Recovery Timeline

Full post-surgery recovery typically takes around 6 to 12 months, depending on the patient, graft type and commitment to physiotherapy.

Pain Management During Recovery

With medication, cold therapy and physical therapy, knee pain and inflammation can be reduced. Patients are encouraged to stay active in moderation.

Criteria for Returning to Sports and Activities

You can return to sport upon regaining full strength, knee stability, and neuromuscular control.

Potential Risks and Outcomes of ACL Surgery

 While ACL reconstruction surgery offers a high success rate, it’s important for patients to understand the potential risks involved, possible long-term effects, and how outcomes can vary depending on individual factors.

Common Risks Associated with ACL Surgery

Like any surgery, ACL reconstruction carries certain risks. These include infection at the surgical site, stiffness or reduced range of motion in the knee, failure of the graft used to replace the ligament, blood clots, and, in rare cases, nerve injury. However, the likelihood of these complications is significantly lowered when the procedure is performed by experienced surgeons following strict protocols.

Long-Term Outcomes and Potential Complications

Most patients who undergo ACL reconstruction with proper surgical techniques and commit to rehabilitation regain full knee function and return to their previous activity levels. Despite successful surgery, some patients may experience long-term complications such as osteoarthritis or recurring instability in the knee, which can affect mobility and quality of life. Continuous follow-up and preventive care are important to manage these risks.

Managing Post-Surgery Pain and Instability

Persistent pain and knee instability after surgery can usually be managed through personalized physical therapy programs focused on strengthening and improving joint stability. If conservative treatment does not resolve these issues or if the ligament is re-injured, revision ACL surgery may be considered to restore proper function and reduce symptoms.

At Medical Park Hospitals in Turkey, we combine advanced surgical expertise with state-of-the-art technology to deliver safe and effective orthopedic care. Our team of experienced orthopedic surgeons and rehabilitation specialists work together to provide individualized treatment plans that prioritize your recovery and long-term joint health. Whether you're an athlete seeking to return to peak performance or an individual looking to regain daily mobility, our patient-centered approach ensures optimal outcomes in ACL reconstruction and beyond. 

Visit our Orthopedics and Traumatology Department page to discover how our specialists provide expert care for complex fractures, ligament injuries, and trauma-related conditions through advanced surgical and non-surgical approaches. For more information on personalized care options for joint injuries and mobility issues in Turkey, see our orthopedic treatment in Turkey guide.

This content was developed by the MedicalPark Editorial Board and is intended for informational purposes only. It does not replace professional medical advice, diagnosis, or treatment. Please consult your healthcare provider for personalized care.