ACL Reconstruction Surgery

The anterior cruciate ligament or ‘ACL’ reconstruction’ is a type of knee surgery which involves replacing one of the stabilising ligaments found between the femur and tibia within the knee joint. This ligament helps keep the joint in place, ensuring stability and enabling a full range of movement without misalignment.

Prior to the operation, the patient will meet with an anaesthetist; a specialist in perioperative medicine who will discuss the various anaesthetic options available. ACL reconstructions are usually performed under a general anaesthetic, where the patient is asleep. However, it can be performed under a spinal anaesthetic where the patient remains conscious but the nerves running to the knee joint are numbed prior to undergoing surgery, ensuring no pain or discomfort.

The procedure is ‘keyhole’, and surgeons make small cuts into the side and front of the knee. This is often done using a small camera, called an arthroscope. This is passed through the skin and into the knee joint to help visualise the damaged area. Once identified, the damaged Anterior Cruciate Ligament will be carefully replaced. Usually, this is done using an autograft, a piece of tissue taken from another part of your body, often from the hamstring or patellar tendon.

The grafted tissue is first removed and then prepared and implanted through a small hole drilled into the front of the knee. The graft is threaded through a drilled tunnel and anchored in place using screws. The correct amount of tension is then applied to allow for normal functioning. Once the graft has been introduced, the wound is then closed using a combination of dissolvable stitches and local anaesthetic to reduce pain. The knee is then kept flexed, allowing for better healing and a greater range of movement once fully healed. In total, the operation will take between 1 and 2 hours to complete.

Following surgery, patients are transferred to the post-operative recovery lounge and looked after by an expert nursing team. It is not unusual to spend up to one night in hospital after the procedure. Surgery is just one part of the treatment and reaching good outcome after ACL Reconstruction relies on diligent physiotherapy.

For further reading:

OrthoInfo: ACL injury - does it require surgery Physio-Pedia: ACL Reconstruction


Shaerf DA., Pastides PS., Sarraf KM. Anterior cruciate ligament reconstruction best practice: A review of graft choice. World Journal Orthopedics. 2014;18(5):22-29.

Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques. World Journal of Orthopedics. 2016;7(2):82-93.