Knee · Dr. Jason Jones

ACL tears and ACL reconstruction

An ACL injury is an over-stretching or tear of the anterior cruciate ligament, one of the four ligaments that keep the knee stable. When the knee keeps giving way, reconstruction replaces the torn ligament with a graft, as an outpatient procedure.

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Dr. Jason Jones performing arthroscopic surgery, watching the camera view on the monitor

At a glance

Hospital stay
Outpatient, home the same day
Surgery
60 to 100 minutes
Brace
4 to 5 weeks
Cutting sports
4½ to 6 months

The graft

Your new ligament

The new ligament is tendon with a plug of bone on each end, which anchors it in the knee. There are several graft options, and Dr. Jones will choose the one best for you.

Patellar tendon

The central portion of your own patellar tendon is taken, with plugs of bone from the kneecap and tibia. This needs a slightly longer incision below the kneecap.

Allograft

Donor tendon with bone plugs, harvested and stored in sterile conditions and specially processed, so no tissue is taken from your own knee.

ACL injuries and treatment

The ACL is a strong fibrous tissue connecting the femur to the tibia. A partial or complete tear makes the knee less stable, and it can feel as though it is about to give out.

Treatment may be operative or non-operative. Right after the injury, most patients are advised to stay off the leg, elevate it, apply ice and take an anti-inflammatory such as ibuprofen. Physical therapy strengthens the surrounding muscles, and a brace may be fitted for activities that stress the knee.

ACL reconstruction, step by step

The surgery is arthroscopic, done through small incisions with a camera.

  1. 01IncisionsSmall incisions (portals) are made around the joint for the camera and instruments. A patellar tendon graft needs one more, slightly longer incision below the kneecap.
  2. 02VisualizationThe camera goes into the knee, and saline flows in to expand the joint. The image goes to a video monitor, where the surgeon can see inside the joint.
  3. 03ACL removalA surgical instrument is inserted into the joint and the torn ACL is removed.
  4. 04Graft insertionA guide wire through the tibia and femur guides the drill, so the new tunnels are accurate. The graft is tied to the guide wire and pulled into place.
  5. 05Securing the graftScrews or staples secure the plugs of bone in the tunnels. Over time, the plugs incorporate into the surrounding bone.
Left, an illustration of an arthroscope and scissors inserted into a knee. Right, a photo of the arthroscope and an instrument in a draped knee during surgery
A camera and instruments inserted through small portals in a knee.

Recovery and return to sport

ACL surgery is an outpatient procedure, and therapy starts within days. Once formal therapy ends, strengthening continues at a gym or health club for another three to six months.

  1. 48 hoursThe bandage comes off, and you may shower.
  2. Days 2 to 4Physical therapy begins.
  3. The first weekCrutches, for about a week.
  4. Weeks 4 to 5The brace comes off.
  5. Six weeksFormal therapy usually ends. Most normal activities resume and jogging is usually allowed, but not cutting and jumping sports.
  6. Three monthsGolf is allowed.
  7. 4½ to 6 monthsAggressive cutting sports such as football, soccer and basketball.

ACL tears in female athletes

A female basketball player is five times more likely to suffer a non-contact ACL tear than a male player at the same level. Anatomical and physiological differences, including a wider pelvis and greater Q angle, a smaller intercondylar notch, greater knee flexibility, foot pronation and the effect of estrogen on ligament laxity, all place more rotational force on the knee.

Coordination and landing technique matter as much as strength. Female athletes tend to land stiff-legged with the knees coming together, and training that changes this reduces knee injuries. Four ways to reduce ACL injuries in your daughter:

  • Leg muscle strength training and core strengthening
  • Neuromuscular (balance and speed) training
  • Coaching on jumping and landing to avoid straight-leg landing
  • Proper footwear, and orthotics if needed

Questions and answers

How long does the procedure last?

Generally between 60 and 100 minutes.

Will I have general anesthesia?

Yes, supplemented by a nerve block to reduce pain when you wake up.

Will I stay in the hospital overnight?

No. ACL surgery is an outpatient procedure.

How long will I be out of work?

At least two weeks, and longer if your work involves heavy lifting, heights, running or jumping.

Your surgeon

Dr. Jason Jones

MD

Dr. Jones is a fellowship-trained sports medicine surgeon specializing in the knee and shoulder. He has performed several thousand knee and shoulder procedures, focused on joint preservation and minimally invasive surgery.

  • Fellowship, Lenox Hill Hospital, New York
  • Assistant team physician, New York Jets and New York Islanders
  • Complex shoulder training in Nice, France, with Pascal Boileau
  • Chairman of Orthopedics, Saint Thomas Hospital
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