ACL Reconstruction: Understanding the Condition + Treatment

This page provides general information for patients of Dr. Borshch in Brisbane, who are preparing for Orthopaedic ACL reconstruction surgery for symptomatic knee instability.

Your individual condition and treatment plan may be different, so this information should be used alongside the advice of your surgeon and treating team.

The anterior cruciate ligament (ACL) is one of the main stabilising ligaments in the knee. It limits forward movement of the tibia (shin bone) relative to the femur (thigh bone) and helps control pivoting, twisting, and sudden changes in direction.

An ACL reconstruction is an operation to replace a torn ACL using a graft (new ligament). The graft is usually made from your own tendon (most commonly hamstring or quadriceps tendon), or less commonly from a donor.

The aim of ACL reconstruction is to:

• restore knee stability
• reduce episodes of the knee “giving way”
• allow a safe return to sport, work, or active daily life
• reduce the risk of further knee damage (especially meniscal injury)

ACL reconstruction is usually considered when the ACL has been torn and the knee remains unstable, particularly during pivoting or sporting activities.

Common reasons include:

• repeated episodes of the knee giving way
• difficulty returning to sport, physical work, or active hobbies
• associated injuries such as meniscus tears
• young or active patients who place high demands on the knee

Not everyone with an ACL tear needs surgery. Some people can manage well with physiotherapy alone, especially if they do not have instability or high sporting demands. Studies show that both surgical and non-surgical pathways can be appropriate depending on the individual. (https://pubmed.ncbi.nlm.nih.gov/20660401/)

Good preparation improves outcomes and speeds recovery.

• Stop smoking/vaping if possible (smoking slows healing).
• Maintain good general health and nutrition.
• Tell the team about any medical conditions or medications.

Pre-operative physiotherapy is very important for ACL surgery. Goals before surgery include:

• reducing swelling
• restoring full knee extension
• strengthening the hamstrings and then the quadriceps

Patients who go into surgery with good movement and strength tend to recover better afterward.

• Arrange time off work or sport as advised.
• Set up space for icing, exercises, and leg elevation.

Your team will advise what medications to stop or continue before surgery.

• ACL reconstruction is usually done as with an overnight stay in hospital.
• Pain is managed with a multimodal pain relief plan.
• You will begin walking with crutches and start simple exercises the same day or next day.

• You will have your first review back in the office (usually with the nurse), this is mainly to check that the incisions are healing well, make sure your pain is controlled and address any other concerns.
• Focus on reducing swelling and regaining knee movement (especially full extension).
• Crutches are gradually weaned as walking improves.
• Regular physiotherapy begins.
• Driving is usually not safe until good control and strength have returned (often 2–4 weeks, depending on side and comfort).

• Progressive strengthening of the hamstrings, quadriceps and hips.
• Balance and control exercises are introduced.
• Light jogging may begin around 3 months in selected patients (under physio guidance).

• Advanced strengthening, agility, and sport-specific training.

Return to pivoting sports is usually not recommended before 9–12 months, as earlier return is associated with a higher risk of re-injury.

Most patients achieve good to excellent knee stability after ACL reconstruction and can return to sport or active lifestyles.

The reconstructed ligament does not fully behave like the original ACL, but it can function very well if rehabilitation is completed properly.

ACL injury (with or without surgery) increases the long-term risk of knee arthritis. Surgery improves stability but does not eliminate this risk. (https://pubmed.ncbi.nlm.nih.gov/35445329/)

Contact our office, your GP, or seek urgent care if you notice:

• increasing redness, warmth, or swelling
• worsening pain after initial improvement
• discharge from the wounds
• fevers or feeling unwell

(Infection after ACL reconstruction is rare, usually <1%.) (https://pubmed.ncbi.nlm.nih.gov/36517215/)

• calf pain or tenderness
• increasing leg swelling
• sudden shortness of breath or chest pain (call emergency services)

• inability to fully straighten or bend the knee despite physiotherapy
• early assessment is important to prevent long-term stiffness

• new instability or giving way after initial improvement
• often related to early return to sport or a new injury