ACL Reconstruction

ACL reconstruction is a minimally invasive arthroscopic (keyhole) surgery done to replace a torn Anterior Cruciate Ligament with a new, healthy graft. The operation is performed through very small incisions around the knee, and once healing is complete, the scars are usually so tiny that most people barely notice them.

The goal of ACL reconstruction is to restore knee stability, prevent the “giving-way” sensation and help patients return to daily activities and sports confidently.

How the Procedure Is Performed?

The surgery is done under spinal anaesthesia (numbing from the waist down) so the patient remains comfortable throughout.

A simplified step-by-step overview of the surgery:

• Two or three small keyhole openings (portals) are made around the knee.
• A camera (arthroscope) is inserted to view the inside of the knee on a monitor — this is called diagnostic arthroscopy.
• The torn ACL fibres are removed using a shaver.
• A graft is harvested either from the patient’s hamstring tendons, peroneus longus tendon, or occasionally from another suitable site.
• The graft is prepared and shaped to match the original ligament.
• Tunnels are created in the femur and tibia, and the graft is positioned in the exact location of the original ACL.
• The graft is fixed at one end, the knee is cycled through 20 bends and straightening movements to ensure proper tension.
• Final fixation is done after confirming stability.
• The wounds are stitched and a sterile dressing is applied.
• Despite the technical complexity, the procedure is designed to minimize tissue injury and speed up recovery.

Choice of graft

The graft acts as the new ACL, so choosing the right one is important.

• For primary ACL surgeries, the preferred choices are:
  • Hamstring tendons (semitendinosus + gracilis)
  • Peroneus longus tendon
• For revision ACL reconstruction (repeat surgery), graft options may include:
  • Bone–patellar tendon–bone (BTB)
  • Quadriceps tendon
• In rare situations where patient grafts are unsuitable, an allograft (donor tendon) may be used.

Each option has its own advantages, and the selection depends on age, activity level, previous surgeries and knee anatomy.

Recovery

Recovery after ACL reconstruction is a structured and gradual process. The aim is to regain full range of motion, muscle strength and knee control while protecting the graft during healing.

Typical rehabilitation milestones:

Time Period	Recovery Milestones
Next day	Walking allowed with full weight bearing, with or without brace
Few days	Desk job / office work possible
Around 6 months	Running and squatting usually allowed
After 7 months	Most sports, except contact sports
After 8 months	Return to contact sports, depending on physiotherapy progress and surgeon clearance

Consistent physiotherapy is essential for the best outcomes. The graft gradually transforms into a strong, functional ligament over several months — this natural “ligamentisation” process is why the timeline is structured.

Key Takeaway

ACL reconstruction not only replaces the torn ligament but also restores knee stability, confidence and long-term joint health. With the right graft choice and dedicated physiotherapy, most patients return to an active lifestyle — including high-demand sports.