Anterior cruciate ligament (ACL) reconstruction

Reconstructive knee ligament surgery using a tendon from elsewhere in the body, typically hamstring, patella tendon or donor (allograft).

About anterior cruciate ligament (ACL) reconstruction

Anterior cruciate ligament (ACL) reconstruction surgery involves using a piece of tendon from your own body (graft) to replace the damaged ACL. This acts as scaffolding for a new ligament to grow along.

The ACL is the thick band of tissue that joins the thigh bone (femur) to the shin bone (tibia). It runs through the middle of the knee joint and stabilises the knee.

The ACL can be completely or partially torn as a result of a sudden twisting movement. It is a common sporting injury in football, squash, skiing and other high intensity activities which involve sudden stopping/changing direction.

Your symptoms are likely to include:

  • pain
  • swelling
  • feeling of instability or the knee giving way
  • loss of power through the leg.

Your orthopaedic surgeon may recommend surgery if an MRI scan of your knee shows a complete tear and your symptoms haven't improved with physiotherapy.

How is ACL reconstruction carried out?

ACL reconstruction is carried out using keyhole surgery (arthroscopically), usually under general anaesthetic.

Your surgeon makes a number of small cuts in your knee and inserts a telescopic video camera and surgical instruments.

They will cut a section of tendon from your thigh (hamstring) or knee (patella tendon) or use a donor graft.

The graft is anatomically placed, carefully tensioned and fixed in place with screws or special buttons attached by stitches to the graft.

The cuts will be closed/stitched and a dressing applied. A knee brace is also normally fitted at the time. The period of time you will need this will vary on the level of damage you have had to your knee.

What happens after surgery?

You will usually be able to go home on the same day as your surgery or the day after.

It’s safe to put weight on your leg as soon as you’re able to get up, but you'll need to use crutches to start with. It usually takes about two weeks before you can walk without crutches and fully bend your knee.

Your physiotherapist will give you some exercises to do while you recover.

Initially, you will need to rest your leg and keep it elevated as much as you can.

You should be able to return to work four to six weeks after the operation if you have a desk job. Those with more physical jobs will need a longer recovery time.

It usually takes six months to make a full recovery and return to sports.

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Published: 10 December 2019 | Review: 10 December 2022

Disclaimer: This information is published by Cromwell Hospital and is based on reputable sources of medical evidence and experience from over 30 years of treating patients. It has been peer reviewed by Cromwell Hospital doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. If you have any feedback on the content of this patient information document please email or telephone 020 7460 5901.