ACL Reconstruction (knee) Orthopedic Surgery

ACL reconstruction is a surgery to replace a torn anterior cruciate ligament (ACL) in the knee.

ACL Reconstruction (knee) procedure illustration

Overview

ACL reconstruction is a surgery to replace a torn anterior cruciate ligament (ACL) in the knee. The surgeon uses a graft, which is a piece of tendon tissue from your own body (autograft) or a donor (allograft), to recreate the ligament. It is done to help stabilize the knee that gives way with pivoting or cutting movements, reduce the risk of further knee damage, and support return to activities when non-surgical care is not enough.

Overview Preparation Clinical Info Recovery FAQ References

Also known as: Anterior cruciate ligament reconstruction, ACL surgery, Knee ligament reconstruction

Recovery
180–365 days
Return to Work
7–180 days

Preparation & Next Steps

Everything you need to know before and after your procedure

Before Care

  • Complete preoperative evaluation and review imaging (such as MRI) with your care team
  • Discuss graft choices (autograft or allograft) and how they may affect recovery and activity goals
  • Begin prehab physical therapy, focusing on swelling control and knee motion as recommended
  • Review all medicines and supplements; ask which to pause or continue before surgery
  • Follow anesthesia fasting instructions and arrive with a responsible adult for pickup
  • Arrange help at home for the first 24–48 hours, including rides and basic tasks
  • Prepare your home: clear walking paths, set up a rest area, have ice packs and pillows ready
  • Obtain crutches and any prescribed brace ahead of time and learn how to use them
  • Perform any pre-op skin cleansing or nasal decolonization steps if instructed
  • Bring a list of allergies, current medicines, and prior surgeries to the check-in

After Care

  • Keep the incision dressing clean and dry; change it only if and when instructed
  • Use ice and elevate the leg to help with swelling during the early recovery period
  • Use crutches and any brace as directed; avoid twisting or pivoting until cleared
  • Take pain medicines only as instructed by your care team; avoid driving while on sedating medicines
  • Start physical therapy on the schedule provided and follow the home exercise plan you are given
  • Move safely and often within your restrictions to lower stiffness and swelling
  • Do not soak the incision (baths, pools, hot tubs) until it is fully healed and you are told it is safe
  • Attend follow-up visits for wound checks, suture or staple removal, and progress assessments
  • Ask when it is safe to return to work, school, driving, and sports based on your job and progress
  • Contact a clinician if you notice fever, worsening pain or swelling, increasing redness or drainage, calf pain, chest pain, or shortness of breath

Clinical Information

Important medical details about this procedure

Indications

  • ACL tear with knee instability or repeated giving way
  • Desire to return to pivoting or cutting sports
  • Combined injuries (for example, meniscus or other ligament tears)
  • Knee instability affecting work or daily activities
  • Failure of non-surgical treatment to meet activity goals

Alternatives

  • Physical therapy focused on strength and neuromuscular training
  • Activity modification to avoid pivoting and cutting
  • Functional knee bracing
  • Watchful waiting with rehab and monitoring
  • Pain and swelling control measures (ice, elevation, medicines as advised by a clinician)

Risks

  • Infection
  • Bleeding or blood clots (deep vein thrombosis or pulmonary embolism)
  • Stiffness or loss of knee motion
  • Graft failure or re-tear
  • Persistent pain or instability
  • Nerve or blood vessel injury
  • Numbness near the incision
  • Donor site pain or weakness (with autograft)
  • Anesthesia-related risks

Contraindications

  • Active infection in or around the knee
  • Poor skin or soft tissue condition that limits healing
  • Inability to participate in required rehabilitation
  • Advanced knee arthritis limiting expected benefit
  • Uncontrolled medical conditions that raise surgical risk

Recovery Timeline

What to expect during your recovery

Early recovery focuses on reducing pain and swelling and regaining knee motion. Many people return to desk work in 1–2 weeks and progress to sports over 6–12 months, depending on rehab progress and any additional knee injuries.

Typical Range

180–365 days

Return to Work

7–180 days

Recovery Milestones

Day 0–3

Control pain and swelling; begin gentle, guided movements as instructed

Day 7–14

First follow-up visit; wound check and suture or staple removal if used

Day 14–42

Transition toward full weight bearing and brace adjustments as cleared

Day 42–84

Build strength and balance; some may start light jogging if cleared

Day 90–180

Advance sport-specific drills without contact when approved

Day 180–365

Gradual return to pivoting or contact sports when testing and clinician clearance are met

Frequently Asked Questions

Common questions and expert answers about this procedure

What happens during ACL reconstruction?

The surgeon removes the torn ACL, creates small tunnels in the bones, places a tendon graft to recreate the ligament, and secures it with implants. The surgery is usually outpatient.

What graft options are used?

Common options include patellar tendon, hamstring tendon, or quadriceps tendon from your body (autograft) or donor tissue (allograft). Each has trade-offs in healing and comfort.

How long does the surgery take?

Many procedures take about 1–2 hours, but time varies based on anatomy and whether other repairs, like meniscus work, are done at the same time.

Will I need a brace or crutches?

Most people use crutches and often a knee brace for a period after surgery. The type and duration depend on your surgeon’s protocol and the specifics of your repair.

When can I return to sports?

Return to cutting and pivoting sports commonly takes 6–12 months. Clearance is based on strength, motion, balance testing, and knee stability, not just time.

What are the main risks?

Risks include infection, blood clots, stiffness, graft failure, persistent pain or instability, nerve or vessel injury, and anesthesia risks.

What if I do not have surgery?

Some people do well with therapy, bracing, and activity changes. Others have ongoing instability that limits sports or work and may risk further knee damage.

Will I need physical therapy?

Yes, a structured rehab program is standard. It focuses on motion early, then strength, balance, and gradual return to higher-level activities.