Anterior Cruciate Ligament (ACL) Surgery

Key Points about ACL Surgery

  • ACL surgery is an orthopaedic procedure to replace a torn anterior cruciate ligament (ACL). The ACL is a ligament that connects the femur (thigh bone) to the tibia (shin bone) and stabilizes the knee joint
  • ACL injuries are common in athletes who play sports such as basketball, soccer, football, and gymnastics, which may involve quickly changing directions, sidestepping, or landing awkwardly.
  • ACL surgery is a minimally invasive surgery where your torn ACL is removed and replaced with a tendon taken from another area of your knee
  • It is usually performed as a minimally invasive procedure in an outpatient setting, and you will be able to go home the day of the procedure.
  • Full recovery and returning to your sport can take as long as a year.


Anterior cruciate ligament (ACL) surgery is a common orthopaedic treatment performed to repair a torn ACL ligament. People who play sports that require pivoting and quick movements such as basketball or football are at greater risk of experiencing an ACL tear. While most patients experience a full recovery, the process can take between 9 to 12 months.

ACL surgery candidates

You may be a candidate for ACL surgery if your ACL tear is complete or if you have other knee injuries in addition to the ACL injury. Criteria used to determine if you are a candidate for ACL surgery include:

  • You are an adult who lives an active lifestyle.
  • You are a child whose growth plates have closed.
  • Regular giving way of the knee, especially during day-to-day activities
  • Inability to participate in sporting activities..
  • Nonsurgical therapies, such as physical therapy, have not been effective.
  • You are an athlete who participates in a sport that involves jumping, cutting, or pivoting,
  • and you want to continue playing your sport.
  • More than one ligament has been damaged in the injury.

You may not be a candidate if:

  • You have a partially torn ACL without any signs of instability or other knee injuries. Generally, nonsurgical therapies such as physical therapy are effective in these cases.
  • You are a child with open growth plates.
  • You have an infection or serious illness.

ACL surgery risks

While ACL surgery is generally a safe procedure, there are some risks associated with the surgery, including:

  • Risk of infection (<0.1%), if you develop infection, you will need more surgery
  • Blood clot. Patients at risk of developing a blood clot may be given medications to prevent blood clots from forming. It is important if you have had blood clots in your legs (DVT) or clots in lungs (PE) in the past, you need to let us know of this information
  • Knee pain. Approximately 20% of patients who have ACL surgery will experience residual pain.
  • Weakness or stiffness in the knee.
  • • The new graft will fail, and the knee will remain unstable. This occurs in approximately 5-10 % of patients. Your doctor will review your case and determine if a subsequent surgery may be effective.
  • Only 2/3 of the patients who have had ACL surgery will be able to return to preinjury level sporting activities.

ACL surgery preparation

Most patients will be required to undergo physical therapy before surgery to reduce pain and swelling as well as restore the knee’s range of motion. If you have surgery before you have a full range of motion in the knee, you may not return to full range of motion after surgery.

ACL surgery expectations

Mr. Ellapparadja will perform arthroscopic surgery (keyhole surgery) to reconstruct your ACL.

Advantages of arthroscopic ACL surgery include:

  • The procedure uses smaller incisions than open surgery.
  • In many cases, it is performed at the same time as a diagnostic arthroscopy procedure that is used to diagnose knee damage.
  • Reduced chances of complications than open surgery.
  • It is a day-case procedure meaning you can go home the same day of surgery.

During ACL surgery, small incisions are made around the knee cap to facilitate entry into the knee joint. An arthroscope with a camera on the end will be inserted into the knee joint through the incision. The camera will send photos to a monitor in the operating room. Small surgical instruments will be inserted into an incision, and your surgeon will drill holes into the upper and lower leg bones. The tissue graft will be anchored through these holes. It will be almost always your own tissues (hamstring graft) that will be harvested to reconstruct the ACL. The graft will be secured into place with screws and staples.

ACL surgery is performed usually under general anaesthesia. Since you will be able to go home on the day of the surgery, it is important to have a driver as you recover from the anaesthesia.

Follow your doctor’s discharge instructions to control pain and reduce swelling. Ice and elevate the leg and rest as much as you can directly after the procedure.

It is essential to go to all your follow-up appointments so your doctor can track your recovery process and tweak if needed.

After ACL surgery

Physiotherapy is recommended as an essential part of your recovery process. Over four to six months, you will gain strength and stability in your knee.

When patients follow their doctor’s recovery and rehabilitation instructions, most patients experience a full recovery after ACL surgery. Total recovery takes approximately nine months. For competitive athletes, you can expect to need 9 to 12 months before returning to play.