ACL Reconstruction

What is ACL Reconstruction?

Anterior cruciate ligament (ACL) reconstruction is a surgical procedure to restore stability to a knee with a torn ACL. Because a completely torn ACL does not reliably heal back to its original strength, reconstruction replaces the damaged ligament with a graft — a piece of tendon that is positioned to function in place of the original ligament. Over time, the body incorporates this graft, restoring the knee’s stability.

The procedure is most commonly considered for active individuals, those who wish to return to pivoting sports, and those with ongoing instability after an ACL tear.

Who Needs ACL Reconstruction?

Reconstruction is generally recommended when:

• There is ongoing instability or the knee gives way with activity
• The patient wishes to return to sports involving pivoting, cutting, or jumping
• There are associated injuries (such as certain meniscal tears) that benefit from a stable knee
• Non-surgical management has not provided adequate stability

Not everyone with an ACL tear requires surgery. Less active patients, or those who do not participate in pivoting activities, may be managed successfully with physiotherapy and activity modification. The decision is individualised.

Graft Options

The graft used to reconstruct the ligament may come from the patient’s own tissue (an autograft) — commonly the hamstring tendons, the patellar tendon, or the quadriceps tendon — or, in some situations, from donor tissue (an allograft). Each option has its own characteristics, and the choice depends on the individual case, including patient factors and the nature of the injury. The most appropriate graft will be discussed with you at your consultation.

The Procedure

ACL reconstruction is typically performed arthroscopically (keyhole surgery). The torn ligament is removed, tunnels are created in the femur and tibia, and the graft is passed through and secured in position to recreate the path of the original ligament. Any associated injuries, such as meniscal tears, may be addressed at the same time. Surgery is performed under spinal or general anaesthesia.

Recovery and Rehabilitation

Rehabilitation after ACL reconstruction is a substantial, structured process and is central to a good outcome. It generally progresses through stages:

• Early phase: protecting the graft, reducing swelling, and restoring movement
• Strengthening phase: rebuilding muscle strength and control
• Functional phase: progressing towards running, agility, and sport-specific training

Return to pivoting sport typically takes many months and is guided by both healing time and meeting functional milestones, rather than a fixed date. Close engagement with a physiotherapy programme is essential throughout.

Risks and Complications

As with any surgery, ACL reconstruction carries risks, including:

• Infection
• Blood clots (deep vein thrombosis or pulmonary embolism)
• Bleeding
• Stiffness or loss of movement
• Graft failure or re-injury
• Ongoing instability or pain
• Injury to adjacent nerves or blood vessels
• Issues at the graft donor site

All relevant risks will be discussed in detail at your consultation.

Frequently Asked Questions

When can I return to sport?

Return to pivoting sport typically takes many months and depends on meeting functional rehabilitation milestones rather than reaching a set date. Returning too early increases the risk of re-injury, so progression is guided carefully by your surgeon and physiotherapist.

Which graft is best?

There is no single best graft for everyone. Hamstring, patellar tendon, quadriceps tendon, and donor grafts each have advantages and considerations. The most appropriate choice depends on your individual circumstances and will be discussed at your consultation.

Can the reconstructed ligament tear again?

Yes, re-injury is possible, particularly with a return to high-risk activities. Completing a thorough rehabilitation programme and returning to sport only when functionally ready helps reduce this risk.

Medical Disclaimer
The information on this page is intended as general patient education and does not constitute medical advice. Every patient is different, and treatment decisions should always be made in consultation with a qualified medical professional based on your individual circumstances, health history, and imaging. Outcomes from surgery vary between patients and cannot be guaranteed. If you have concerns about your knee health or are considering surgery, please contact Dr Slattery’s rooms to arrange a consultation.