Anterior Cruciate Ligament (ACL) Reconstruction

What Different Kinds of Grafts Are Used?

There are several graft options for ACL reconstruction. The choice depends on age, activity level, and surgeon preference.

This is sourced from your own gracilis and semitendinosus tendons.

Advantages: Small incision, less anterior knee pain, easier to rehab quadriceps.

Disadvantages: Loss of hamstring strength, higher graft rupture rate.

This is sourced from the middle third of patellar tendon with bone plugs.

Advantages: Lowest graft rupture rate.

Disadvantages: More anterior knee pain, longer recovery from kneeling, weakness in quadriceps, increased risk of contralateral ACL tear.

This is sourced from a partial thickness quadriceps tendon.

Advantages: Large, strong graft; low donor site pain.

Disadvantages: Quadriceps weakness, unknown graft failure rate compared to other grafts.

This is sourced from a cadaver tissue bank.

Advantages: No donor site pain, easier post-operative rehabilitation.

Disadvantages: Higher graft failure rate in younger/active patients.

• Hospital stay: You will typically be admitted to hospital for one night, but there are situations where you can be sent home the day of surgery.

• Weight bearing: You will usually begin walking with crutches immediately after surgery.  Some forms of meniscus repairs may restrict your weight-bearing for 6 weeks. 

• Brace: A knee brace is not normally used after ACL reconstructions.  A brace will only be used to protect some types of meniscus repairs that occur during the same procedure. 

• Ice and elevation: Regular icing and leg elevation reduce swelling and pain.  A compression ice machine can be hired from a 3rd party.

• Physiotherapy: Early exercises begin within days to restore knee motion and prevent stiffness, especially regaining full extension.  You should start riding a stationary bike right away after surgery.

• It is normal for the top dressing to become moist with arthroscopic fluid in the first 1–2 days.

• After 1-2 days, remove the outer dressing and leave the smaller waterproof dressings in place.

• Dressings may be removed completely after 7 days.

• Incisions typically heal within two weeks.

• Showers are permitted while the wounds are covered with waterproof dressings during the first 2 weeks.

• Do not submerge incisions in water (baths, pools, ocean) for 4 weeks.

• A wound check with your GP at the two-week mark is recommended.

• Absorbable sutures are typically used and do not require removal, though occasionally small remnants may naturally surface during healing.

Blood clots (deep vein thrombosis or pulmonary embolism) are uncommon but can occur after surgery.
You can reduce the risk by:

• Moving your foot and ankle regularly while resting.

• Walking early with assistance.

• You will likely be instructed to take aspirin for 2-4 weeks to prevent DVT/PE.

• Avoiding long periods of sitting or immobility.

Seek immediate medical attention if you develop calf pain, swelling, chest pain, or shortness of breath.

• Use ice regularly (20 minutes at a time, several times per day).  You may hire an ice machine from a 3rd party.

• Take prescribed pain relief medications as directed.  Opioid medication can be used but they cause nausea, vomiting, constipation, and dependance; thus, non-opioid medications should be prioritized when medically tolerated. 

• Use a compressive dressing on the knee for 6-12 weeks to help with swelling

• Begin gentle range-of-motion and muscle activation exercises as soon as recommended.

• Use walking aids to help with walking

You should contact your surgeon or clinic immediately if you notice:

• Increasing redness, swelling, or foul-smelling drainage from the wound.

• Persistent or worsening pain not controlled by medication.

• Fever, chills, or night sweats.

• Calf pain or swelling (possible blood clot).

• Acute injury to your operative extremity.

Prompt review allows early management of potential complications.

• You can usually drive when you can safely control the vehicle and perform an emergency stop comfortably.

• This is typically around 4–6 weeks after surgery for right knee surgery, and 2-3 weeks for the left knee.

• You must not drive while taking strong pain medication (e.g., opioids).

Return to work depends on your occupation:

• Office or sedentary work: 1–2 weeks (once you can safely commute).

• Light manual work: 4–6 weeks.

• Heavy manual labour: 3–4 months or longer, depending on recovery.

Yes. Physiotherapy is essential for optimal recovery and long-term success after ACL reconstruction.
Your physiotherapist will:

• Guide you through a structured rehabilitation program.

• Focus on restoring range of motion, strength, balance, and neuromuscular control.

• Progress exercises gradually from early mobility to return-to-sport conditioning.

Most patients continue physiotherapy for 6–12 months to achieve full recovery, including returning to sport.

While ACL reconstruction is highly successful, all surgeries carry risks.
Possible complications include:

• Infection (rare)

• Blood clots (DVT/PE)

• Knee stiffness or loss of motion

• Persistent swelling or pain

• Numbness around incision sites

• Graft failure or re-rupture (particularly if returning to sport too early)

• Hardware irritation

• Donor site pain

• Residual instability

• Progression of arthritis

• Failure of meniscus repair

• Weakness of thigh musculature

• Inability to return to sport

Return to activities depends on the nature and intensity of the recreation
This is a general guideline:

• Running: once knee swelling and pain have resolved, typically 3-4 months

• Non-cutting activities/sport (golf, cricket, surfing, etc), typically 6-9 months

• Training for sport, typically 6-9 months

• Cutting sports (football, rugby, basketball, netball, etc), typically 9-12 months

Returning to sports before 9 months increases your risk of ACL graft tears.  Unfortunately, not all patients can return to their previous activities/sports.