ACL Surgery

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Having knee weakness from a torn anterior cruciate ligament (ACL) can be scary. You may wonder how you'll return to activities you previously enjoyed. You may struggle to get around, or even to complete your normal daily activities.

Surgery can reconstruct a torn ACL, making it easier to use your knee. For many, surgery is able to restore a full range of motion, as well as balance and strength.

Reasons to Have ACL Surgery at UVA Health. 

ACL surgery is an elective procedure. Depending on your situation, your doctor may advise not getting ACL surgery. But surgery is often advised. Especially if you have: 

  • A complete tear of the ACL
  • A high degree of joint instability
  • Injury to the knee that affects more than one ligament
  • A need to return to sports or other activities that require pivoting, turning, or sharp movements
  • No improvement with rehabilitative therapy

What to Expect During ACL Surgery

Most people aren't sure what to expect from joint surgery. While every surgery and recovery is a little different, here are some general expectations. 

Prior to the Procedure

Your doctor may do the following:

  • Physical exam
  • Blood tests
  • Knee X-ray
  • MRI to see the internal structure of the knee

Before surgery, you will need to:

  • Arrange for help at home while you recover
  • Talk to your doctor about any medications, herbs, or supplements you are taking
  • Talk to your doctor about any allergies you have
  • Ask your doctor about assisted devices you will need


Anesthesia will block pain and keep you comfortable during the procedure. Anesthesia methods include:

  • General anesthesia is given through an IV. You will be asleep during the procedure.
  • Spinal anesthesia is given through the spine and keeps your legs numb. The doctor may give you a sedative to keep you relaxed and ease anxiety.

What Happens During ACL Surgery?

You'll have an IV placed in your arm to supply medication and fluids. The doctor will examine your knee and confirm the ACL tear. They'll also confirm your expectations for the procedure and mark your leg for surgery.

Your new tendon will either come from another tendon in your knee or hamstring (an autograft) or from a donor (an allograft). In either instance, your doctor will reshape your new tendon to the right size. Both autografts and allografts have similar outcomes. Which your doctor uses will depend on the condition of your other tendons and your overall health. 

The doctor will make one or two small incisions (keyhole incisions) on the top of your knee. They'll then use an arthroscope and tiny tools to remove the torn ACL. They'll also repair the damage. Your surgeon will drill holes through your thigh and shin to secure the new graft. They'll then secure the graft in place using sutures, screws, washers, or staples. 

Once the graft is securely in place, the doctor will test the knee’s range of motion. They'll test the graft to make sure everything is secured correctly. Then, they'll sew your knee closed. You'll need a bandage for the first few days. Follow your doctor's instructions on how long to leave the bandage on and how to remove it. 

How long will the procedure take?

About two hours.

How much will it hurt? 

Anesthesia will block pain during the procedure. You will have pain after the procedure. Ask your doctor about medication to help manage pain.

How long do I need to stay in the hospital? 

This procedure is done in a hospital setting. You can usually go home the same day. If you have complications, you may need to stay longer.

Post-procedure Care

At the Hospital

After the procedure, the hospital staff may provide the following care:

  • Monitor your vital signs as you recover from the anesthesia
  • Medication to manage pain
  • Antibiotics to prevent infection
  • Medication that prevents blood clots
  • Place ice packs on your knee
  • Show you how to use a continuous passive motion machine
  • Teach you how to use crutches or knee brace

At Home

When you return home, take these steps:

  • Take pain medication as directed
  • Use crutches or knee brace for as long as the doctor recommends
  • Work with a physical therapist
  • Gradually begin low impact activities, such as swimming or cycling, to strengthen the knee
  • Keep the incision area clean and dry
  • Ask your doctor about when it is safe to shower, bathe, or soak in water
  • Be sure to follow your doctor’s instructions

ACL Repair: Risks

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Infection
  • Excess bleeding
  • Blood clots
  • Reaction to anesthesia
  • The operation does not provide the desired improvement in function
  • Instability of the knee
  • Numbness or stiffness in the knee
  • Kneecap pain after surgery

Smoking may increase the risk of complications and slow healing.

When To Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Swelling, pain, or heat in your calves
  • Pain cannot be controlled with medications given
  • Nausea or vomiting
  • Cough, shortness of breath, or chest pain
  • Numbness in the knee area
  • Trouble urinating
  • New or worsening symptoms

If you think you have an emergency, call for medical help right away.