Anterior Cruciate Ligament ACL Reconstruction: What You Need to Know
- Agile Ortho
- Feb 26
- 3 min read
Introduction
If you've been told that you need Anterior Cruciate Ligament (ACL) reconstruction, you're likely dealing with knee instability, pain, or difficulty engaging in physical activities. This blog will guide you through the structure and function of the ACL, the surgical process, rehabilitation, and what to expect post-surgery.
Understanding the procedure and recovery is essential to achieving the best results. If you have any additional questions, consult your surgeon or physiotherapist.
What is the ACL?
The Anterior Cruciate Ligament (ACL) is one of two cruciate ligaments located in the centre of your knee. These ligaments cross each other, forming an “X” shape—hence the name "cruciate." The ACL runs from the outer aspect of the femur (thigh bone) to the inner aspect of the tibia (shin bone), preventing excessive forward movement of the tibia and controlling rotational movements of the knee.
Functions of the ACL:
Prevents excessive forward movement of the tibia.
Controls rotational movement of the knee.
Ensures smooth knee motion during activities like walking, running, and jumping.
ACL Injury and Diagnosis
A torn ACL often occurs due to sudden twisting, pivoting, or impact injuries—common in sports like football, basketball, and skiing. Symptoms include:
Knee instability or "giving way."
Immediate swelling and pain.
Difficulty bearing weight on the injured leg.
How is an ACL Tear Diagnosed?
Physical Examination: A skilled clinician can often diagnose an ACL tear without an MRI.
MRI Scan: This helps confirm the diagnosis and assess damage to other structures in the knee.
Arthroscopy (Keyhole Surgery): In some cases, a minor surgical procedure is used to confirm the extent of the damage.
ACL Reconstruction Surgery: What to Expect
Why Surgery?
Since a torn ACL often does not heal on its own, or heals in the wrong place leaving it dysfunctional, surgical reconstruction is often recommended to restore knee stability and function.
Graft Choices for ACL Reconstruction
Since the ACL cannot be repaired directly, surgeons use alternative tissue (grafts) to reconstruct the ligament. Options include:
Hamstring Tendon Graft (Preferred Choice) – Harvested from the inner thigh; offers less post-op pain and better function.
Patellar Tendon Graft – Uses the central part of the kneecap tendon; provides strong fixation but may cause more post-op discomfort.
Quadriceps Tendon Graft – Taken from the top of the knee; an option if other grafts are not viable.
The Surgical Process
General anaesthesia is used for most ACL reconstructions.
The procedure is performed arthroscopically (using small incisions and a camera for precision).
The selected graft is fixed in place using surgical screws or other fixation devices.
Surgery typically lasts 1-2 hours.
Most patients stay in the hospital for one night before discharge.
Recovery and Rehabilitation
A structured rehabilitation program is essential for regaining knee function and strength.
General Timeline for Recovery
0-2 weeks: Focus on reducing swelling, restoring full knee extension, and gentle movement exercises.
2-6 weeks: Gradual weight-bearing and strengthening exercises.
6-12 weeks: Light gym activities, swimming, and progressive strengthening.
3-6 months: Jogging and balance training.
6-9 months: Non-contact sports training.
9-12 months: Full return to contact sports.
Key Rehabilitation Goals
Early movement is crucial. Avoiding stiffness is key to a successful recovery.
Strengthen supporting muscles. Focus on quadriceps, hamstrings, and core stability.
Proprioception training. Balance and coordination exercises help restore knee function.
Gradual return to activity. Rushing back to sports too soon can increase the risk of re-injury.
Potential Risks and Complications
While ACL reconstruction has a high success rate, some risks include:
Knee stiffness (minimised with proper rehab)
Persistent pain or numbness around the surgical site
Swelling and bruising
Deep Vein Thrombosis (DVT) (blood clot risk—minimised with movement and hydration)
Infection (rare but serious)
Graft failure (approx. 10% risk over five years)
It’s essential to follow post-operative care instructions and notify your surgeon if you experience severe pain, swelling, or signs of infection.
Important Travel Considerations
After ACL surgery, air travel can increase the risk of blood clots.
General Recommendations:
Avoid long-haul flights for at least 6 weeks.
Wear compression stockings to reduce swelling.
Move frequently during flights—walk up and down the aisle every hour.
Stay hydrated and avoid excessive alcohol intake.
If travel is necessary, discuss blood-thinning medication with your doctor.
Conclusion
ACL reconstruction is a well-established procedure that can restore knee stability and allow a return to an active lifestyle. However, a successful outcome depends on rehabilitation and patient commitment to the recovery process.
If you have any concerns about your surgery, rehabilitation, or potential complications, don’t hesitate to contact your surgeon or physiotherapist.
By following a structured rehab program and giving your knee time to heal, you’ll be well on your way to regaining full function and returning to the activities you love!
