ACL Tear Surgery: Step-by-Step Process and Recovery Timeline
An Anterior Cruciate Ligament (ACL) tear is a common sports injury that can significantly affect knee stability and function. In our previous blog, we discussed ACL injuries, their causes, symptoms, and non-surgical treatment options. However, when conservative treatments fail or in cases of complete ligament rupture, ACL reconstruction surgery is the most effective solution to restore knee stability.
In this blog, we will take you through the step-by-step surgical process and provide a detailed recovery timeline for ACL reconstruction.
Step-by-Step ACL Surgery Process
1. Pre-Surgical Preparation
Before undergoing ACL surgery, your orthopedic specialist will recommend a set of preoperative steps:
Medical Evaluation: Blood tests, imaging (MRI/X-ray), and physical assessments to determine the extent of the injury.
Prehabilitation: Strengthening exercises and physiotherapy to reduce swelling, restore range of motion, and improve muscle tone.
Patient Counseling: Discussion about the type of graft (autograft from hamstring, patellar tendon, quadriceps tendon, or allograft from a donor).
Fasting & Medication Guidelines: Instructions to avoid food intake before surgery and adjust medication if necessary.
2. Anesthesia & Incision
The patient is given general anesthesia or spinal anesthesia to ensure a pain-free experience.
The surgeon makes small incisions around the knee to insert the arthroscopic camera and surgical instruments.
3. ACL Graft Selection & Harvesting
Depending on the chosen graft type:
Hamstring Tendon Graft: Taken from the inner thigh.
Patellar Tendon Graft: Taken from below the kneecap.
Quadriceps Tendon Graft: Taken from above the kneecap.
Allograft (Cadaver Graft): Taken from a deceased donor.
The harvested graft is prepared to replace the damaged ACL.
4. ACL Preservation & Tunnel Creation
In ACL-preserving surgery, one band of the ACL is preserved for better recovery.
The surgeon removes only the damaged portion of the ACL using arthroscopic tools.
Bone tunnels are drilled into the femur (thigh bone) and tibia (shin bone) to secure the new graft.
5. Graft Placement & Fixation
The prepared graft is inserted through the bone tunnels and fixed using screws, buttons, or sutures.
The graft is tensioned to ensure stability and proper knee movement.
6. Final Inspection & Closure
The surgeon checks graft positioning and knee stability.
The incisions are closed with sutures, and the knee is wrapped in a sterile dressing.
A knee brace or immobilizer is applied to protect the newly reconstructed ACL.
Immediate weight-bearing with brace support is started on the same day post-surgery.
Post-Surgical Recovery Timeline
Recovery after ACL surgery is a gradual process, divided into multiple phases.
Phase 1: Immediate Post-Surgery (0-2 Weeks)
Goals : Reduce swelling, manage pain, prevent stiffness .
Rehabilitation :
RICE (Rest, Ice, Compression, Elevation) technique .
Pain management with prescribed medications .
Gentle range-of-motion exercises .
Immediate weight-bearing with brace support .
Phase 2: Early Rehabilitation (2-6 Weeks)
Goals : Regain knee motion, start weight-bearing .
Rehabilitation :
Progressive physical therapy to improve quadriceps strength.
Controlled weight-bearing with knee brace support.
Stationary cycling and light exercises.
Phase 3 : Strength & Stability (6-12 Weeks)
Goals : Increase muscle strength and knee control .
Rehabilitation :
Resistance training for leg muscles .
Balance and proprioception exercises .
Increased walking and stationary cycling .
Phase 4 : Advanced Rehabilitation (3-6 Months)
Goals : Restore near-normal function and prepare for sports activities .
Rehabilitation :
Jumping, agility, and light jogging exercises .
Sport-specific drills (if applicable) .
Continued strengthening exercises .
Phase 5 : Return to Sports (6-8 Months)
Goals: Full functional recovery with minimal risk of re-injury .
Rehabilitation :
High-intensity training with cutting and pivoting movements.
Gradual return to competitive sports under medical supervision.
Key Takeaways
ACL reconstruction is a minimally invasive procedure with a high success rate.
Immediate weight-bearing with brace support is started on the same day post-surgery.
ACL-preserving surgery retains one band of the ACL for better recovery.
Strict adherence to rehabilitation ensures successful recovery and prevents re-injury.
Returning to sports should be gradual and guided by a specialist.
For more insights on preventing ACL injuries and conservative treatment approaches, refer to our previous blog on ACL injuries.
If you’re dealing with an ACL tear and considering surgery, consult Dr. Kamal Kishor Gupta, an expert in sports injuries and knee stability management in Lucknow.