Anterior Cruciate Ligament (ACL) Reconstruction Surgery

Due to the nature of the ACL, it is unlikely to be repaired by suturing. In rare cases this may be possible, however outcomes are typically less successful over the long term then a full ACL reconstruction. Further, those who wish to return to significant activity including cutting sports will almost surely need a reconstruction for the tear.

The reconstruction of the ACL involves replacing the torn ligament with grafted tissue either from the patient’s own body (autograph) or from a donor (allograft). Grafting this tissue creates a foundation for the ligament to grow back and eventually restores the stability of the knee. If using a patient’s own tissue, the graft can be taken from the patellar or hamstring tendons. On occasion, the quadricep tendon can be used as well. While the patient’s own tissue usually offers the best long-term results, donor tissue may be used if the patient’s tissue is compromised in some way. A consultation with Dr. Manning will determine the best way forward and what kind of graft to use.

ACL Reconstruction Procedure

Before surgery, we look to return the joint to a more normal state despite the fact that it cannot handle strenuous activity. Therefore, physical therapy is often indicated. The goal is to eliminate swelling, stiffness and improve range of motion before surgery. Doing so increases the likelihood that normal knee function will be maintained after surgery as well.

An ACL reconstruction procedure is performed arthroscopically – a minimally invasive procedure that requires only tiny incisions in the knee versus a large single incision. To begin, a small camera is inserted into the knee to allow Dr. Manning to visualize the tear and the surgical area. Once this diagnostic arthroscopy has been completed, the procedure can begin.

Dr. Manning starts by removing the torn ligament, which in the majority of cases, cannot be repaired. Small holes will be drilled into the thigh bone and shinbone. A tendon graft from patient’s own body or from a donor is then attached using a fixation device (screws, etc). This graft serves as a scaffolding for additional tissue to grow in place.


As a result of the procedure being performed arthroscopically, most patients will be able to return home on the day of surgery. Patient will be sent home with crutches and most likely a knee brace or splint. Taking it easy, icing and elevating the leg and taking anti-inflammatory medication is important for proper recovery and pain management. Eventually, then you will be able to hold weight.

Over the course of several weeks, patient will undergo progressive physical therapy to improve range of motion and strength and stabilizing muscles around the knee. The scope of the rehabilitation plan will vary based on the results of surgery and any co-occurring injuries.

Full recovery from an ACL reconstruction and return to somewhat normal activity can take six to nine months. Returning to sports can take a while longer – up to 12 months. Over the course of this time, the body creates new ligament tissue over the graft.

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