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ACL Surgery After Injury: 8 Things You May Not Know

ACL (anterior cruciate ligament) tears are one of the most common knee injuries. For many people, surgery to reconstruct the ligament is the preferred treatment. This is especially true for people with complete ACL tears who want to return to an active lifestyle. Knee surgery is also the preferred treatment when other knee injuries are present. This is the case in about half of ACL tears. If you’re facing ACL surgery, here are some important facts to know.

African American male patient in physical therapy using stretch band on leg

1. You will likely need physical therapy before surgery.

An ACL tear can cause significant swelling and stiffness. It’s important to resolve these symptoms before you have surgery. People who have limited range of motion in their knee before surgery tend to have difficulty recovering motion after surgery. Preoperative physical therapy will help you restore full range of motion and avoid this problem. It typically takes at least three weeks to regain full range of motion after an ACL injury. You may also need a knee brace during this time before surgery.

Close-up of Asian American surgeon operating on patient

2. ACL surgery uses a tendon graft.

Experience has shown doctors that using sutures to repair a torn ACL eventually fails. Instead, doctors generally replace the ACL with a tendon graft. Most often, doctors take a piece of the patellar—or kneecap—tendon. The remaining tendon will heal and regrow the missing portion over time. Your body uses the graft as a kind of scaffolding to heal a new ACL-like structure. Other graft options include using tendons from a cadaver or from your own quadriceps or hamstring muscles.

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3. A patellar tendon graft is the gold standard for ACL surgery.

Using a patellar tendon graft is a common choice for ACL surgery. Compared to other tendon grafts, it often has the best long-term outcomes and lower failure rates. Doctors often recommend it for athletes. However, it has some drawbacks. This includes pain behind the kneecap, pain with kneeling, and postoperative stiffness. There is also a slight risk of kneecap fracture.

4. ACL surgery is minimally invasive.

ACL surgery is arthroscopic surgery. It involves making small incisions in the knee to insert the arthroscope and surgical instruments. An arthroscope is a thin, lighted tool with a camera on the end. It allows your doctor to view the inside of the joint during surgery. Your doctor will remove the damaged ACL and drill into the bones above and below your knee. These tunnels will position the tendon graft and screws or other hardware will anchor it in place. Your doctor will verify the correct graft tension (tautness or stiffness) and ensure your knee moves as expected before completing the surgery.

Rear view of surgeons operating on patient with surgical instruments in foreground

5. ACL surgery with an autograft involves another incision and ACL surgery scar.

An autograft is a graft that comes from your own body. An allograft comes from a cadaver. Using an autograft has several advantages, but it also changes the surgery. In addition to the ACL incisions, you will have another, possibly larger incision over the area where the doctor harvests the tendon. For a patellar tendon graft, the incision will be underneath the kneecap. The surgery also tends to be longer and involve more postoperative pain with an autograft.

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6. ACL surgery recovery can be lengthy.

ACL surgery is outpatient surgery. It’s easy to think that going home right after a surgery means it’s not such a big deal. But ACL surgery involves a significant recovery. You will be off your feet for some time. Typically, you need crutches to keep weight off your knee for a couple of weeks. You will also be in physical therapy rehabilitation for several months after surgery. In general, it can take six months or longer to fully recover from ACL surgery. For athletes, it an take up to a year to return to sports.

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7. Insurance usually covers ACL surgery.

If you are concerned about ACL surgery cost, check with your insurance company. Most plans cover the surgery when it is medically necessary. This may require some documentation from your doctor. Your doctor’s office will help you navigate any preauthorization you need. You should also find out about your out-of-pocket costs. Your insurance provider can help you understand your responsibility for copays, deductibles or co-insurance costs.

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8. ACL surgery is usually successful.

ACL surgery can usually restore knee stability and function, even for athletes. However, the results often depend on adequate and thorough rehabilitation. This means you must commit to following your therapist’s instructions and attending all your appointments. You will need to be diligent about your home exercises. And you will need to refrain from adding activities before your therapist gives you the green light. Keep your long-term goals in mind during your recovery—the time you invest in your recovery will pay off in the end!

8 Surprising Facts About ACL Surgery

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