The anterior cruciate ligament (ACL) is a band of tissue deep within the knee joint that connects the thigh bone (femur) to the shin bone (tibia). This ligament is a primary stabilizer, preventing the tibia from sliding too far forward and controlling the knee’s rotational movement. A tear often occurs during sports that require sudden stops, pivoting, or awkward landings, such as basketball, soccer, or skiing. When the ACL is completely torn, the knee can become unstable, leading to a feeling of the joint “giving way” during everyday movements. For active individuals, or those with associated injuries like a torn meniscus, surgical reconstruction is often the most effective path to restoring stability and function.
Understanding the Surgical Approach
ACL surgery is a minimally invasive procedure, and the correct term is arthroscopic surgery, not laparoscopic surgery. Arthroscopy refers to a procedure performed within a joint, such as the knee, shoulder, or hip. The surgeon uses a small fiber-optic camera, called an arthroscope, inserted through tiny incisions. This camera transmits a magnified image of the knee’s interior structures onto a monitor, allowing visualization without a large open incision.
The confusion with the term laparoscopic arises because both techniques involve small incisions and a camera. However, laparoscopy is reserved for procedures performed within the abdominal or pelvic cavities, such as gallbladder removal or hernia repair. Since ACL reconstruction is a joint procedure, arthroscopy is the appropriate term. This method reduces trauma to surrounding tissues, resulting in less post-operative pain and a quicker initial recovery compared to traditional open surgery.
Key Steps of ACL Reconstruction
The procedure begins with preparing a tissue graft to replace the damaged ligament. This graft is commonly sourced from the patient’s own tissue (autograft), often using the hamstring, patellar, or quadriceps tendon. Alternatively, a graft from a deceased donor (allograft) may be used. Once prepared, the surgeon makes small incisions, or portals, around the knee to insert the arthroscope and specialized instruments.
Inside the joint, the surgeon first removes the remnants of the torn ACL to clear the path. Tunnels are then drilled in the femur and the tibia at the original ACL attachment sites. Proper alignment of these tunnels is required to ensure the reconstructed ligament functions correctly and restores rotational stability to the knee.
The prepared graft is pulled through the femoral and tibial tunnels. Fixation secures the new ligament into the bone tunnels using devices like interference screws, metal buttons, or staples. Over time, the body’s natural healing process integrates the graft into the bone, a process called ligamentization, transforming the tendon tissue into a new, functional ligament.
Recovery and Return to Activity
Recovery from ACL reconstruction is a lengthy process requiring a structured physical therapy program that begins almost immediately after surgery. In the immediate post-operative phase, the primary goals are to control pain and swelling and ensure the knee achieves full extension. Patients typically use crutches and a brace for initial protection and begin weight-bearing as tolerated within the first few days or weeks.
The early rehabilitation phase focuses on gradually restoring the knee’s full range of motion while protecting the healing graft. Physical therapy progresses to include exercises designed to reactivate and strengthen the quadriceps and hamstring muscles.
In the intermediate phase, from roughly two to four months, intensity increases to rebuild strength, endurance, and balance. Activities progress to include stationary cycling, light resistance training, and proprioception exercises to improve the body’s sense of joint position. The final phase involves advanced strengthening and sports-specific training, including agility, jumping, and cutting maneuvers. A full return to competitive, pivoting sports usually takes between nine and twelve months.