What you can expect

In most instances, general anesthesia is used during ACL reconstruction, so you'll be unconscious during the procedure. ACL reconstruction is usually done through small incisions — one to hold a thin, tube-like video camera (arthroscope) and others to allow surgical instruments access to the joint space.

During the procedure

In ACL reconstruction the surgeon removes the damaged ligament rather than repairing it. The damaged ligament is replaced with a segment of tendon, tissue similar to a ligament that connects muscle to bone. This replacement tissue is called a graft. Your surgeon will use a piece of tendon from another part of your knee or a tendon from a deceased donor.

Your surgeon will drill sockets or tunnels into your thighbone and shinbone to accurately position the graft, which is then secured to your bones with screws or other fixation devices. The graft will serve as scaffolding on which new ligament tissue can grow.

After the procedure

Once you recover from the anesthesia, you'll be allowed to go home later that same day. Before you go home, you'll practice walking with crutches, and your surgeon may ask you to wear a knee brace or splint to help protect the graft.

Before you leave the hospital, you will receive instructions on when you can shower or bathe, when you should change dressings on the wound, and how to manage post-surgery care. To reduce swelling and pain in the days immediately following your surgery, follow the R.I.C.E. model of self-care at home:

  • Rest. General rest is necessary for recovery after surgery. Follow your surgeon's advice on how long to use crutches and limit weight-bearing on your knee.
  • Ice. When you're awake, try to ice your knee at least every two hours for 20 minutes at a time.
  • Compression. Wrap an elastic bandage or compression wrap around your knee.
  • Elevation. Lie down with your knee propped up on pillows.

Progressive physical therapy after ACL surgery helps to strengthen the muscles around your knee and improve flexibility. A physical therapist will teach you how to do exercises that you will perform either with continued supervision or at home. Adhering to a rehabilitation plan is important for proper healing and achieving the best possible outcomes.

Dec. 19, 2015
  1. Friedberg RP. Anterior cruciate ligament injury. http://www.uptodate.com. Accessed Oct. 10, 2015.
  2. Frontera WR. Anterior cruciate ligament tear. In: Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed Oct. 22, 2015.
  3. Knee arthroscopy. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00299. Accessed Oct. 15, 2015.
  4. ACL injury: Does it require surgery? American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00297. Accessed Oct. 15, 2015.
  5. DeLee JC, et al. Anterior cruciate ligament injuries (including revision). In: DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed Oct. 22, 2015.
  6. Knee arthroscopy exercise guide. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00300. Accessed Oct. 15, 2015.
  7. Shea KG, et al. The American Academy of Orthopaedic Surgeons evidence-based guideline on management of anterior cruciate ligament injuries. Journal of Bone and Joint Surgery. 2015;97:672.
  8. Stuart MJ (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 28, 2015.