Reconstruction of the Anterior Cruciate Ligament (ACL)

The anterior cruciate ligament (ACL) is one of the key stabilising ligaments of the knee. When it is torn, the knee can feel unstable, give way during activity and be at higher risk of further joint damage.

Through our medical tourism agency Pax Medicus, patients can access modern arthroscopic ACL reconstruction, tailored rehabilitation and specialist orthopaedic care in reputable partner centres.

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What Does the ACL Do?

The ACL is a strong ligament inside the knee joint that connects the femur (thigh bone) to the tibia (shin bone). It is crucial for knee stability and for protecting other internal structures of the joint.

Prevents the tibia from sliding too far forward under the femur.
Provides stability during twisting and pivoting movements.
Contributes to proprioception – the body’s ability to sense joint position and movement.
Helps protect the menisci and cartilage from overload and injury during sport and daily activities.

How Is an ACL Injury Diagnosed?

Diagnosis combines a careful medical history, physical examination and imaging. Even if swelling settles, an undiagnosed ACL rupture can lead to ongoing instability and progressive joint damage.

Clinical assessment

Discussion of how the injury occurred and current symptoms.
Specific ligament tests such as the Lachman test, anterior drawer, Lever sign and pivot-shift test.
Assessment of range of motion, swelling and tenderness.

Imaging

MRI – gold-standard test to assess the ACL, menisci and cartilage.
Ultrasound (US) to evaluate soft tissues and effusion.
X-ray or CT scans when bone injury or more extensive damage is suspected.

What Is an ACL Injury?

ACL injuries usually occur during sports that involve sudden stops, changes of direction or jumping, such as football, basketball, handball and skiing. The ligament may be stretched, partially torn or completely ruptured, with a full rupture causing significant instability.

Typical injury mechanisms

Twisting injury with the foot fixed on the ground.
Sudden change of direction or deceleration.
Landing awkwardly from a jump.
Excessive valgus (inward) or varus (outward) force on a straight leg.

Associated injuries

Medial collateral ligament (MCL) and medial meniscus damage (O’Donoghue’s “unhappy triad”).
More extensive combinations involving both cruciate ligaments, collateral ligaments and both menisci.
Cartilage injuries that raise the risk of osteoarthritis.

Typical symptoms after rupture

Immediate swelling due to bleeding inside the joint.
Sharp pain and difficulty bearing weight.
Feeling of “giving way” or instability.
Flexion contracture – difficulty fully straightening the knee.

When Is ACL Reconstruction Recommended?

ACL reconstruction is usually advised for patients with a complete ACL rupture who wish to return to sport or physically demanding work. Surgery restores mechanical knee stability and helps protect the joint from further damage.

Recurrent giving way or instability during normal activities.
Desire to return to sports involving pivoting, jumping or sudden direction changes.
Combined injuries (e.g. ACL rupture with meniscal or collateral ligament damage).
Younger or active patients where long-term joint preservation is a priority.

Less active or older patients may be treated conservatively in selected cases, but chronic instability can accelerate cartilage wear and osteoarthritis.

Preparing for ACL Reconstruction

Pre-operative assessment

Detailed medical history and physical examination.
MRI, ultrasound and other tests to confirm the diagnosis and plan treatment.
Discussion of activity level, expectations and choice of graft type.

Prehabilitation & anaesthesia

Prehabilitation to improve knee motion, muscle strength and circulation.
In high-demand athletes, surgery may be scheduled within 7–10 days; in others, a short delay allows optimal prehabilitation.
Anaesthetist consultation to decide on spinal or general anaesthesia and review pre-operative instructions.

ACL reconstruction is performed arthroscopically, using small incisions and a camera. This minimally invasive approach allows precise graft placement with less soft-tissue trauma and typically faster recovery.

Arthroscopic technique

Small keyhole incisions around the knee.
Arthroscope (camera) and instruments introduced into the joint.
Assessment and treatment of associated injuries (e.g. meniscal tears).
Creation of bone tunnels in the femur and tibia.

Reconstruction & fixation

A tendon graft is positioned along the anatomical course of the ACL.
Fixation with devices such as Endobutton implants and bioabsorbable screws.
Intra-operative checks of knee range of motion and graft tension.
Joint irrigation, placement of drains and skin suturing.

Surgical techniques

Single-bundle reconstruction – one graft replacing both ACL bundles (most common technique).
Double-bundle reconstruction – two grafts recreating the anteromedial and posterolateral bundles for enhanced rotational stability.
Internal bracing – in selected recent injuries, the native ligament is repaired and reinforced with a strong tape instead of a graft.

Internal bracing and modern fixation systems aim to preserve healthy tissue, support faster rehabilitation and reduce the risk of re-injury in carefully selected cases.

Autografts (patient’s own tissue)

Most commonly used – immunologically safest option, as the body recognises the tissue as its own.
Hamstring tendons (semitendinosus and gracilis) – strong, reliable grafts with excellent long-term results.
Patellar tendon graft – similar structure to the ACL with very high mechanical strength.
Quadriceps tendon graft – often used in revision cases or complex injuries.

Allografts (donor tissue)

Grafts obtained from carefully screened donors and processed in tissue banks.
Avoids graft harvesting from the patient, reducing operative trauma and scarring.
Often considered in revision surgery or in selected patients where autograft options are limited.

Synthetic reinforcement (LARS)

LARS (Ligament Advanced Reinforcement System) uses a synthetic ligament to bridge ACL stumps
Eliminates graft harvesting and may shorten surgery and early rehabilitation.
Preserves proprioception and can be helpful in selected recent injuries with good-quality ligament stumps.

Benefits of ACL Reconstruction

ACL reconstruction aims to restore a stable, functional knee and reduce the risk of further damage to cartilage and menisci. For many patients, it allows a safe return to sport and active living without chronic instability.

Improved knee stability in daily activities and sport.
Reduced episodes of giving way and falls.
Lower risk of progressive joint degeneration and early osteoarthritis.
Better protection of menisci and cartilage over the long term.
Personalised choice of graft and technique based on age, goals and injury pattern.

Through our medical tourism agency Pax Medicus, you can access experienced orthopaedic surgeons, modern arthroscopic techniques and coordinated rehabilitation pathways designed to support a safe and confident return to activity.

Recovery After ACL Reconstruction

Rehabilitation is essential for a successful outcome. The overall timeline varies between patients, but structured physiotherapy and adherence to medical advice are key.

Early phase

Hospital stay is usually short; many patients are discharged on the second day.
Knee brace and crutches are used for protection and controlled weight-bearing.
Physiotherapy typically starts within a few days of surgery, focusing on swelling control and gentle motion.

Walking & return to work

Independent walking without crutches is often possible after 4–6 weeks.
Return to work is usually considered around 10 weeks, depending on job demands.
Follow-up visit at 10–14 days for stitch removal; joint aspiration may be performed if fluid accumulates.

Return to sport

Light, non-contact sports and controlled training from around 3 months, if rehabilitation is progressing well.
Full return to pivoting and high-impact sports is usually not recommended before 8 months.
Final decisions are made by the surgeon and physiotherapist based on strength, control and confidence.

Rehabilitation plans are individual and depend on healing capacity, graft type, associated injuries and adherence to physiotherapy exercises.

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Disclaimer
*The Pax Medicus website provides information for guidance only and does not constitute medical advice, diagnosis, or treatment. Pax Medicus does not provide healthcare services and is not a substitute for consultation with a qualified medical professional. Always seek advice from your physician regarding any medical condition. Prices shown are indicative only and subject to confirmation by the healthcare provider. This is the official website of Pax Medicus; we do not operate through agents or third-party sites.

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