Surgery for Anterior Cruciate Ligament (ACL) Injury

The ACL (anterior cruciate ligament) is a band of tough, fibrous tissue that helps stabilize the knee. Injury to this ligament often happens when the knee is forced beyond its normal range of motion. This can stretch or tear the ligament, much like the fibers of a rope coming apart. Both surgical and nonsurgical treatment has been used to recover from an ACL tear. Several types of surgery are available based on you and your healthcare provider's preferences, as well as other factors. Some surgeons will operate soon after an ACL tear. Others prefer several weeks of physical therapy first. There are also different anesthesia choices available.

Front view of knee joint showing tear in anterior cruciate ligament.

Preparing for surgery

Do's and don'ts:

  • Stop taking aspirin and other blood thinning medicines 7 or more days before surgery as advised by your healthcare provider.

  • Arrange to get crutches to use during recovery.

  • Follow any directions you are given for not eating or drinking before surgery.

  • Arrange for an adult to drive you home after surgery. 

During surgery

The most common type of surgery for an ACL injury is reconstruction. Several types of surgeries are used:

  • Patellar tendon graft. This uses a piece of your own patellar tendon between the kneecap and tibia.

  • Quadriceps tendon graft. This uses a piece of your own quadriceps tendon between the quadriceps muscle and the knee cap.

  • Hamstring tendon graft. This uses a piece of your own hamstring tendon between the hamstring muscle and the tibia.

  • A cadaver (allograft) tendon graft. This uses any one of several tendons from a cadaver.

To rebuild your ACL, your surgeon may do open surgery or arthroscopy. During arthroscopy, a long, thin tube with a tiny camera is inserted into the knee joint so your surgeon can see inside the joint. Tools inserted through small incisions are used to repair the joint.

Front view of knee showing graft repair of anterior cruciate ligament.

After surgery

Here is what to expect:

  • You’ll spend a few hours in a recovery area. You’ll have ice on your knee to prevent swelling, and your leg may be in a brace.

  • You may get a continuous cooling machine to relieve swelling and pain.

  • You may get medicines to reduce pain and swelling. Take these as prescribed by your healthcare provider.

  • Depending on the procedure, physical therapy may begin shortly after surgery. This may include light exercises. In some cases, you may use a CPM (continuous passive motion) machine for a time. This machine flexes and extends the knee, keeping it from getting stiff.

  • You can usually go home the same day as surgery. Have an adult family member or friend give you a ride.