ACL Reconstruction Surgery - Recovery & Long-Term Outcomes
Restore your knee’s stability and movement with expert ACL reconstruction surgery. Follow a clear recovery plan for safe, long-term results.
ACL Reconstruction Surgery Treatment
An anterior cruciate ligament (ACL) injury is one of the most common and challenging knee injuries, especially in athletes and active individuals. When the ACL is torn, the knee can feel unstable, painful, and prone to giving way, making it difficult to return to sport or even perform daily activities.
For many patients, ACL reconstruction surgery offers the best chance of restoring knee stability, preventing further joint damage, and regaining confidence in movement. This comprehensive guide explores what ACL reconstruction involves, recovery timelines, treatment options, and answers to common patient questions.
What Is ACL Reconstruction?
ACL reconstruction is a surgical procedure that replaces the torn anterior cruciate ligament with a graft, usually taken from the patient’s hamstring, quadriceps tendon, or patellar tendon. In some cases, a donor graft (allograft ACL reconstruction) may be used.
Unlike ACL repair, which tries to stitch the ligament together, ACL reconstruction surgery uses graft tissue to provide long-term stability. This makes it the gold standard for complete ACL tears.
When Is ACL Reconstruction Needed?
You may need ACL reconstruction if you experience:
- A complete ACL tear confirmed on MRI
- Knee instability or “giving way” during activity
- Inability to return to sports or physical work
- Associated injuries such as meniscus tears requiring repair
ACL tears rarely heal on their own. While mild sprains can improve with physiotherapy, many patients with instability benefit from reconstruction.
Types of ACL Reconstruction
There are several techniques used depending on patient age, activity level, and surgeon preference:
- Hamstring ACL reconstruction – uses hamstring tendons, common in athletes.
- Quadriceps tendon graft – ideal in revision or larger patients.
- Allograft ACL reconstruction – donor tissue, suitable for older or less active patients.
- ACL reconstruction with meniscus repair – often performed when there are combined injuries.
- Arthrex ACL reconstruction / keyhole arthroscopy – minimally invasive technique using advanced fixation devices.
- ACL reconstruction with lateral tenodesis or LET ACL reconstruction – additional procedure to protect the graft in high-risk athletes.
- Patellar tendon graft (BTB graft ACL reconstruction) – often used in high-level athletes, provides excellent strength.
The ACL Reconstruction Surgery Procedure
- Performed arthroscopically (keyhole) under general anaesthetic
- Torn ACL remnants are removed
- Drill tunnels are made in the femur and tibia
- Graft tissue is placed and fixed with screws or buttons
- The knee is checked for stability
The operation typically takes 60–90 minutes. Patients usually go home the same day or after one night in hospital.
Cost of ACL Reconstruction
The ACL reconstruction cost varies depending on whether surgery is done privately or within the NHS.
- Private ACL reconstruction surgery cost: Usually includes surgeon, anaesthetist, hospital stay, physiotherapy, and follow-ups.
- Costs may vary with graft choice, complexity (e.g., revision ACL reconstruction), or combined procedures like meniscus repair.
If you are considering private treatment, always ask for a clear breakdown of ACL reconstruction surgery cost and aftercare.
Recovery Timeline After ACL Reconstruction
ACL reconstruction recovery requires structured rehabilitation. Typical milestones:
- Week 1–2: Swelling reduction, gentle movement, walking with crutches and a knee brace
- Week 3–6: Full extension, quadriceps strengthening, light cycling
- Week 6–12: Progressive strengthening, balance training, jogging on treadmill
- Month 4–6: Running, plyometrics, sports-specific drills
- Month 6–12: Return to competitive sport after physiotherapy clearance
ACL reconstruction recovery time off work depends on job type:
- Desk jobs: 2–3 weeks
- Physical jobs: 3–6 months
- Professional athletes: 9–12 months
Rehabilitation and Physiotherapy
A tailored ACL reconstruction rehab protocol is crucial for successful recovery. Key aspects include:
- Early range of motion and swelling control
- ACL reconstruction exercises – closed-chain strengthening, balance, proprioception
- Gradual loading with resistance bands and gym-based exercises
- Functional progression to running, jumping, and pivoting
- Return-to-sport testing before full clearance
Failure to follow a proper ACL reconstruction physiotherapy program is a leading cause of graft failure.
Risks and Complications
While most patients recover well, potential risks include:
- Infection
- Stiffness or extension lag
- Graft re-tear or failed ACL reconstruction
- Blood clots (rare)
- Pain around the donor graft site (hamstring or patellar tendon)
Long-Term Outlook
With modern techniques, ACL reconstruction success rates exceed 90%. Many athletes return to their pre-injury level of sport.
However, ACL injury can increase the long-term risk of osteoarthritis, especially if there are associated meniscus injuries.
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FAQs
Yes, but it is performed arthroscopically with small incisions, allowing quicker recovery than traditional open surgery.
Mild to moderate pain is common initially but improves with medication and physiotherapy.
Yes, if the first graft fails, revision ACL reconstruction is possible.
Most reconstructions last 10–20 years, with many patients returning to sports.
Usually within a few days, with crutches for support.
Most patients return at 9–12 months, depending on rehabilitation progress.
Hamstring, patellar tendon (BTB), and quadriceps grafts all have excellent outcomes. The choice depends on activity level and surgeon recommendation.