ACL surgery When is it needed How to prepare for it and how to recover afterward
The anterior cruciate ligament (ACL) reconstruction is one of the most common surgical procedures performed to treat knee injuries, especially in cases of ACL tears.If you’ve been suffering from persistent knee pain or lost your ability to play sports due to an injury, surgery might be the best solution to restore the natural movement and function of your knee joint.But what should you know before undergoing this procedure? And how can you prepare for it to ensure a successful surgery and a fast return to your normal daily activities?In this Dalily Medical article, we’ll explore the importance of ACL reconstruction surgery and highlight the key instructions you should follow before and after the operation to achieve full recovery and the best possible results.
What Is the Success Rate of ACL Surgery?
ACL reconstruction surgery is considered one of the most successful orthopedic procedures, with a success rate of around 90% in most cases. After the operation, patients usually regain their normal knee function and can return to sports and daily activities. The procedure is very common, and our surgeons have extensive experience performing it — ensuring excellent outcomes and a safe recovery.
What Type of Anesthesia Is Used During ACL Surgery?
ACL reconstruction is typically performed under general anesthesia, meaning the patient is completely asleep during the operation.
However, in some cases, spinal (epidural) anesthesia may be preferred. In this method, the patient remains awake while a local anesthetic is injected into the spinal canal to numb the lower part of the body.
The anesthesiologist will decide the most suitable option based on the patient’s overall health and preferences.
Will I Feel Pain After ACL Surgery?
It’s normal to experience some pain after any surgery, but our goal is to keep it to a minimum. In most cases, doctors use nerve block techniques during the procedure, which help reduce pain for up to 30 hours post-surgery.
After that, pain can be effectively managed with regular pain medications. Our priority is to ensure your comfort and minimize discomfort throughout the recovery period.
What Are the Risks of Not Undergoing ACL Surgery?
Leaving an ACL tear untreated can lead to several complications, including:
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Knee instability: A torn ligament can cause the joint to become unstable, increasing the risk of knee twisting or giving way.
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Cartilage wear: Lack of ligament support puts extra stress on the cartilage, leading to early arthritis or joint inflammation.
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Muscle weakness: Reduced mobility due to pain can cause the thigh and calf muscles to weaken over time.
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Limited daily activity: Simple tasks or physical activities may become difficult or painful.
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Joint degeneration: Untreated ACL injuries increase the risk of osteoarthritis and chronic inflammation later in life.
Can You Live with a Complete ACL Tear?
Living with a complete ACL tear can be very challenging, especially for people with active lifestyles or those involved in sports.
In most cases, surgery is the best option to restore knee stability and prevent further joint damage.
However, some people may choose to live with the injury depending on certain factors, such as:
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Age and activity level: Older adults or less active individuals may adapt without surgery.
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Physical therapy: A structured rehabilitation program can strengthen surrounding muscles and improve joint stability.
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Lifestyle modification: Avoiding high-impact or twisting movements can help reduce stress on the knee.
Still, ignoring a complete ACL tear can worsen knee function over time. Below are the possible complications that may occur:
Potential Problems from Living with an Untreated ACL Tear:
1. Meniscus Tears
An ACL tear can lead to meniscus damage, which cushions the bones and prevents friction. This tear may cause pain, swelling, and an increased risk of osteoarthritis over time.
2. Damage to Other Tendons or Ligaments
The injury may also affect nearby structures, such as the collateral ligaments or patellar tendon, making the condition more complex and prolonging recovery.
3. Structural and Functional Changes
Over time, instability from an ACL tear can cause abnormal knee movement patterns, making everyday tasks — such as walking or climbing stairs — more difficult.
4. Swelling and Inflammation
A torn ACL can trigger inflammation, resulting in pain and swelling that limit flexibility and restrict natural movement.
5. Increased Risk of Osteoarthritis
The instability caused by a torn ACL can lead to abnormal bone friction, significantly increasing the risk of degenerative joint disease (osteoarthritis).
6. Bone Deformities
In some cases, long-term instability may cause changes in bone alignment due to altered knee mechanics.
???? Types of ACL Surgery
ACL reconstruction can be performed using several techniques depending on the patient’s condition, overall health, and recovery goals.
1. Arthroscopic Surgery
Description: The most common ACL repair technique, performed using a small camera and specialized instruments through tiny incisions.
Steps:
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Insertion of a camera to visualize the inside of the knee.
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Removal of the damaged ligament and placement of a new graft through small cuts.
Advantages: Faster recovery, less pain, and lower risk of infection.
Disadvantages: May not be suitable for highly complex injuries.
2. Open Surgery
Description: A larger incision is made to access the knee joint directly, often used for complex cases.
Steps:
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A larger incision exposes the entire knee joint.
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The torn ligament is removed and replaced with a graft.
Advantages: Better for complex or multi-ligament injuries.
Disadvantages: Longer recovery time and higher risk of infection and swelling.
3. Autograft Reconstruction
Description: Uses a graft taken from the patient’s own body — usually from the hamstring or patellar tendon.
Advantages: Lower risk of rejection and excellent tissue compatibility.
Disadvantages: Pain and longer healing time at the donor site.
4. Allograft Reconstruction
Description: Uses a graft from a donor or tissue bank.
Advantages: No pain at the donor site and shorter surgery time.
Disadvantages: Small risk of tissue rejection and requires thorough screening for infections.
5. Synthetic Graft Reconstruction
Description: Uses artificial materials such as polyethylene or carbon fibers to create the ligament.
Advantages: No need for a donor or additional surgical site.
Disadvantages: May be less durable in the long term and requires careful follow-up.
6. Biological Scaffold / ACL Regeneration Technique
Description: A modern, experimental method that uses biological materials and stem cells to stimulate the growth of new ligament tissue.
Advantages: Promotes natural tissue regeneration and reduces the need for synthetic grafts.
Disadvantages: Still under research and not yet widely available.
7. Bridge-Enhanced ACL Repair (BEAR Technique)
Description: Involves the use of a special medical implant to connect the torn ends of the ligament and promote natural healing.
Advantages: Faster recovery and reduced rehabilitation time.
Disadvantages: Limited availability and currently in the research phase.
Reasons for Undergoing ACL Surgery
ACL (Anterior Cruciate Ligament) surgery is performed to repair or reconstruct a torn or injured ligament in the knee. The ACL is one of the key ligaments that stabilize the knee during movement. In some cases, surgery becomes necessary to restore normal knee function and prevent further damage.
Below are the main reasons why doctors may recommend ACL reconstruction:
1. ACL Tear
The most common reason for ACL surgery is a complete or partial tear of the ligament.
This usually occurs due to sudden movements such as rapid stops, twisting of the knee, or abrupt changes in direction — common in sports like football, basketball, or skiing.
2. Knee Instability
After an ACL tear, patients often feel instability or looseness in the knee while walking, running, or performing physical activities.
If left untreated, this instability can lead to abnormal joint movement and worsen over time.
3. Failure of Conservative Treatment
In mild or partial ACL injuries, non-surgical treatments such as physical therapy or knee braces may be used.
However, if these methods fail to restore knee stability or reduce symptoms, surgery becomes the best option to regain proper joint function.
4. Cartilage Damage or Joint Wear
A torn ACL can lead to meniscus or cartilage injuries, increasing the risk of osteoarthritis in the long term.
This may result in chronic knee pain and decreased mobility.
5. High Physical Activity or Sports Participation
Athletes and individuals who engage in high-intensity sports may require ACL surgery to prevent recurrent injuries and ensure a full return to performance.
6. Age and Lifestyle Factors
Younger and more active patients are usually advised to undergo surgery to regain full knee stability and prevent future joint problems.
7. Accurate Diagnosis of Injury
If imaging tests (like MRI or X-rays) show a complete ACL tear with a high risk of further injury, surgery is often considered the most effective option.
8. Combined Injuries
In some cases, the ACL tear occurs along with other knee injuries, such as meniscus or tendon tears.
Surgical intervention allows for the repair of all damaged structures at once.
9. Faster Recovery
Undergoing surgery can reduce recovery time and help the patient return to daily life and sports activities more quickly than with non-surgical treatments.
???? Steps of ACL Reconstruction Surgery
ACL reconstruction is a precise surgical procedure designed to restore the torn ligament in the knee. Here’s how it’s typically done:
1. Anesthesia
General anesthesia is the most common option, keeping the patient completely unconscious during the procedure.
In rare cases, spinal or local anesthesia may be used depending on the patient’s health condition.
2. Surgical Preparation
The surgical area around the knee is cleaned and sterilized with an antiseptic solution to minimize the risk of infection.
Then, a small incision is made near the knee to begin the procedure.
3. Removal of the Damaged Ligament
If the ACL is completely torn, the surgeon carefully removes the damaged tissue.
Any associated injuries to the cartilage or tendons are also repaired during the same operation.
4. Graft Placement (Ligament Reconstruction)
The damaged ligament is replaced using a graft, which can be obtained from different sources:
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Autograft: Tissue taken from the patient’s own body, usually from the patellar or hamstring tendon.
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Allograft: Tissue taken from a donor (tissue bank).
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Synthetic graft: In rare cases, an artificial ligament made from biocompatible materials is used.
The graft is then secured with screws or bioabsorbable pins to ensure stability.
5. Joint Stabilization
After the graft is fixed, the surgeon ensures the joint is properly aligned and stable.
If there is additional damage (to cartilage or tendons), it is repaired at this stage.
6. Wound Closure
The incision is closed with medical sutures, and depending on the surgical method, there may be multiple small incisions.
7. Dressing and Sterilization
Finally, the knee is covered with a sterile dressing to protect against infection and promote proper healing.
⚖️ Comparison Between ACL and PCL Surgery
| Criteria | ACL Surgery (Anterior Cruciate Ligament) | PCL Surgery (Posterior Cruciate Ligament) |
|---|---|---|
| Ligament Location | Front of the knee – prevents the shinbone from moving forward | Back of the knee – prevents the shinbone from moving backward |
| Common Cause | Sports injuries involving sudden stops or changes in direction (e.g., football, basketball) | Severe trauma such as car accidents or direct impact |
| Type of Injury | Complete or partial tear of the anterior ligament | Complete or partial tear of the posterior ligament |
| Diagnosis | Physical exams (e.g., Lachman test) or MRI | MRI and specific knee stability tests |
| Surgical Technique | Arthroscopic reconstruction using autograft or allograft | Arthroscopic or open surgery with graft reconstruction |
| Surgery Duration | 1.5 – 2 hours | 2 – 3 hours (more complex) |
| Recovery Time | 6–9 months to return to sports | 9–12 months due to slower healing |
| Rehabilitation Focus | Early physical therapy for muscle strength and mobility | Longer rehabilitation to restore knee stability |
| Possible Complications | Instability, swelling, long-term arthritis | Difficulty controlling movement, joint stiffness |
| Surgical Methods | Arthroscopic repair with tendon graft | Arthroscopic or open repair using special techniques |
| Long-Term Risks | Re-injury, joint degeneration | Limited full athletic recovery, motion issues |
| Affected Activities | Sports requiring rapid stops and direction changes | Sports involving deep bends or forward-backward motion |
???? Post-Surgery Care: What to Expect After ACL Surgery
After undergoing ACL surgery, proper care and adherence to your doctor’s instructions are essential for a smooth recovery. Here’s what you should keep in mind:
1. Rest and Elevate the Knee
In the first few days after surgery, keep your knee elevated to minimize swelling.
You can use ice packs to relieve pain and reduce inflammation.
2. Stitches Removal
Stitches are typically removed about 10 days after surgery.
Afterward, you can resume gentle showering and continue following your post-operative care plan.
Post-ACL Surgery Care: What to Expect and How to Recover
3. Complete Rest for the Knee
You should keep your knee fully rested for about 6 weeks after surgery. You’ll receive a medical leave certificate for this period, as well as crutches to help with movement and reduce pressure on the knee.
4. Preventing Blood Clots
During recovery, it’s important to take blood-thinning medications as prescribed until your leg can safely bear your full body weight.
5. Physiotherapy
Intensive physical therapy is crucial to prevent muscle loss and to restore the knee’s natural movement and strength.
6. Planning Your Travel
Avoid scheduling your return trip earlier than 10 days after surgery. Ideally, your flight should be 14 days post-operation to ensure safe travel and sufficient initial recovery.
Additional Recovery Information
| Category | Details |
|---|---|
| Hospital stay | 3–4 days |
| Ideal recovery stay | 10–14 days |
| Earliest possible travel | After 10 days |
| Recommended travel time | After 14 days |
| Showering allowed | After 10 days |
| Recommended sick leave | 6–8 weeks (depending on job type) |
| Stitches removal | After 10 days |
| Outpatient physiotherapy | 2 weeks |
| Driving allowed | After 6 weeks |
| Light sports activities | 3–6 months after surgery |
| Regular sports activities | Around 9 months after surgery |
What Should I Do If Pain Prevents Me from Sleeping After ACL Surgery?
Many patients experience difficulty sleeping due to pain and swelling after ACL reconstruction. Here are some effective tips to help you sleep better and reduce discomfort:
1. Take Prescribed Painkillers
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Follow your doctor’s instructions: Take your medications regularly as prescribed.
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Anti-inflammatory drugs like ibuprofen or naproxen can help reduce swelling and pain, but always consult your doctor before taking them, especially if you’re on other medications.
2. Apply Cold Compresses
Place an ice pack or cold compress wrapped in a towel on your knee for 15–20 minutes several times a day, especially before bedtime.
⚠️ Never place ice directly on your skin to avoid frostbite or irritation.
3. Elevate Your Leg While Sleeping
Use a comfortable pillow under your leg to keep it slightly elevated. This helps reduce swelling and pressure while improving blood circulation.
4. Relax Before Bedtime
Practice deep breathing, meditation, or gentle muscle relaxation to ease tension and anxiety caused by pain. Listening to calm music can also help you fall asleep faster.
5. Use a Knee Brace or Support
Wear the brace or immobilizer prescribed by your doctor to stabilize your knee and prevent sudden movements during sleep.
6. Avoid Sudden Movements While Sleeping
Move your leg slowly and carefully if you need to change positions to avoid putting stress on the surgical site.
7. Check Your Mattress and Pillows
Make sure your mattress and pillows are comfortable and provide proper support. A mattress that’s too hard or too soft may increase pain.
8. Eat a Light Snack Before Bed
A light snack rich in magnesium or calcium (like yogurt or bananas) can help relax your muscles and improve sleep quality.
9. Avoid Stimulants Before Bedtime
Stay away from caffeine, tea, or coffee a few hours before bed, as these can increase restlessness and reduce sleep quality.
10. Consult Your Doctor
If pain persists or becomes unbearable, consult your surgeon. They may adjust your medications or prescribe stronger pain relief options or injections.
Best Sleeping Positions After ACL Surgery
1. Sleeping on Your Back (Best Position)
This is the safest and most recommended position:
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Place a pillow under your calf or between the knee and ankle to slightly elevate the leg.
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Avoid putting direct pressure on the surgical area.
2. Sleeping on Your Side
If you prefer sleeping on your side:
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Place a pillow between your knees to keep your leg straight and reduce pressure on the injured knee.
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Avoid lying directly on the operated leg.
3. Avoid Sleeping on Your Stomach
This position increases pressure on the knee and may worsen swelling or discomfort.
4. Use a Knee Support Pillow
A small pillow or bolster under the knee can help maintain a stable position and prevent unwanted bending or twisting.
5. Avoid Staying in One Position for Too Long
Gently move your leg occasionally during the night to improve circulation and prevent blood clots.
6. Monitor Comfort and Stability
Ensure that your brace or support device fits properly and doesn’t cause pressure points or pain.
7. Apply Cold Compress Before Sleeping
If your knee feels swollen or painful, apply a cold pack before bed to ease inflammation and promote comfort.
8. Sleep in a Calm Environment
Choose a quiet, comfortable sleeping space with minimal distractions to promote deep, restorative sleep — essential for faster healing.