What Is ACL Repair?
ACL repair involves reattaching the torn ACL to its original location. Rather than replacing the entire ACL, the surgeon restores the torn ends so the ligament can heal naturally. However, this approach is only suitable for specific tear patterns and is not recommended for most ACL injuries.
Certain ACL tear patterns are more suitable for ACL repair rather than reconstruction. These generally include the following:
- Proximal Tears: The tear occurs near the top of the ligament, close to its attachment to the femur (thigh bone), where healing potential is typically better.
- Acute Tears: The injury is recent, usually within a few weeks, meaning the ligament tissue is still of sufficient quality to allow repair.
- Avulsion Tears: This type of tear occurs when the ligament is pulled away from the bone while the ligament tissue itself remains largely intact.
- Minimal Tissue Damage: The remaining ligament tissue is healthy and strong enough to hold surgical sutures without tearing.
ACL repair is performed using arthroscopic techniques. During the procedure, sutures or small anchors are used to reattach the torn ligament to its original anatomical position. This approach aims to preserve the patient’s own ligament tissue, although its success depends largely on the location of the tear and the quality of the remaining ligament.
What Is ACL Reconstruction?
ACL reconstruction is widely used to treat ACL tears, particularly when the ligament cannot be repaired. It is commonly recommended for complete tears, individuals planning to return to sports or physically demanding activities, and cases where the tear pattern or ligament tissue quality makes ACL repair unsuitable.
Unlike ACL repair, which focuses on preserving the existing ligament, reconstruction involves replacing the damaged ACL entirely to restore stability to the knee.
During the procedure, the torn ligament is removed and replaced with a graft that acts as a new ligament. The replacement ligament is created using a graft, which may be taken from the patient or from a donor. This graft is positioned along the natural pathway of the original ACL to help the knee regain normal movement and support.
Risks of ACL Repair and Reconstruction
Both ACL repair and ACL reconstruction are generally safe procedures, but as with any surgery, they carry potential risks. The type and likelihood of complications can vary depending on the surgical technique used, the extent of the injury and individual patient factors.
General risks associated with both procedures may include:
- Infection at the surgical site
- Blood clots, particularly in the leg veins, after surgery
- Joint stiffness or reduced range of motion during recovery
- Repair or graft failure, where the ligament does not heal or function as intended
- Need for revision surgery if knee stability is not adequately restored
Your orthopaedic surgeon will discuss risks specific to your condition, explain how these risks are managed and outline steps taken during recovery to reduce complications.
Recovery and Rehabilitation
Recovery after ACL surgery involves a structured and progressive physiotherapy programme tailored to the individual. While recovery timelines can vary depending on the procedure performed and patient factors, rehabilitation generally follows several key phases.
1. Immediate Post-Surgery Phase (0–2 weeks)
The initial focus is on managing pain and swelling while restoring gentle knee movement. Early exercises help prevent stiffness and encourage muscle activation, and walking aids or a brace may be used.
2. Early Rehabilitation Phase (2–6 weeks)
During this phase, the knee’s range of motion is gradually improved. Light strengthening exercises are introduced to support the muscles around the knee and promote stability during everyday movements.
3. Strength and Functional Training (6–12 weeks)
Rehabilitation progresses to more targeted strengthening exercises aimed at improving knee control, balance and coordination.
4. Advanced Training (3–6 months)
More challenging movements and sport-specific or high-impact drills are gradually introduced. The goal is to restore strength, confidence and functional performance while minimising the risk of reinjury.
5. Full Return to Sports (6–12 months)
Return to competitive or high-impact sports is considered only after the patient meets specific strength and functional criteria set by their orthopaedic surgeon and physiotherapist.
If you are experiencing knee instability, repeated episodes of giving way, ongoing swelling or difficulty returning to daily or sporting activities, it may be helpful to consult an orthopaedic specialist. A clinical assessment, together with imaging scans, can help determine whether ACL repair, reconstruction or non-surgical management is most appropriate for your condition. Contact us today to arrange a consultation at the International Orthopaedic Clinic.
