What Is ACL Reconstruction?
ACL reconstruction is a surgical procedure that restores knee stability following a complete anterior cruciate ligament rupture. The torn ligament cannot be repaired by stitching, instead, a tendon graft is used to replace the ACL.
Graft Options
Hamstring tendon graft (semitendinosus and gracilis) is the most commonly used in Australia. A section of the hamstring tendon is taken from the same leg, folded to create a strong four-strand graft, and used to replace the ACL. Donor site morbidity is generally low.
Patella tendon graft (bone-patella tendon-bone) is a strong option preferred by some surgeons and patients, particularly in high-demand athletes. It involves a longer recovery from the donor site.
Quadriceps tendon and allograft (donor tendon) are used in selected cases.
The Operation
ACL reconstruction is performed arthroscopically (keyhole surgery) under general anaesthetic. The surgeon creates tunnels in the tibia and femur at the anatomic attachment points of the native ACL. The graft is passed through the tunnels and fixed with screws or other fixation devices. Surgery takes approximately 1–1.5 hours and is a day procedure.
Rehabilitation
Structured physiotherapy is the cornerstone of ACL reconstruction recovery. A phased program progresses from range of motion and quadriceps activation, through strengthening, to sport-specific training and neuromuscular retraining. Return to full competitive sport is criteria-based and typically takes 9–12 months.
Associated Injuries
Up to 50% of ACL ruptures are accompanied by meniscal tears, cartilage injuries, or both. These are addressed at the time of ACL reconstruction. Concomitant meniscal repair does extend the recovery timeline but significantly reduces long-term risk of knee arthritis.