In short
ACL reconstruction does not repair the torn ligament. It replaces it with a graft. Which graft is used affects your recovery, and it is worth understanding the trade-offs.
ACL reconstruction is one of the most frequently performed sports operations in the world. The name is precise: it reconstructs the ligament rather than repairing it, because a torn ACL does not heal reliably when stitched back together.
What happens during the operation
The surgery is arthroscopic. A camera and instruments are introduced through small incisions. The remnants of the torn ligament are cleared, and any meniscal or cartilage damage is addressed at the same time — often the more important part of the operation for long-term knee health.
Tunnels are then drilled through the shin bone and thigh bone at the precise points where the original ligament attached. The graft is passed through these tunnels, tensioned and fixed with implants. Over the following months the graft gradually remodels into ligament-like tissue.
Graft choices
Hamstring tendon
The most commonly used graft in India. Two tendons from the inner thigh are harvested and folded to form the graft. Advantages include a small incision and no front-of-knee pain, which matters for anyone who kneels frequently. Some patients notice mild hamstring weakness early in recovery.
Patellar tendon
A strip of the patellar tendon with small bone blocks at each end. Bone-to-bone healing in the tunnels is fast and secure, and it has a long track record in high-demand pivoting athletes. The trade-off is a higher rate of pain when kneeling and anterior knee discomfort.
Quadriceps tendon
Increasingly used, offering a thick, strong graft with less kneeling pain than the patellar tendon. It is a reasonable option in revision surgery and in patients with particular anatomy.
The first few weeks
Most patients go home the same day or the next. Weight bearing with crutches usually begins immediately unless a meniscal repair requires protection. The early goals are simple and non-negotiable: get the knee fully straight, control swelling, and switch the thigh muscle back on.
Rushing this phase causes stiffness, which is far harder to fix than weakness. A knee that will not straighten at six weeks is a bigger problem than a knee that is not yet strong.
Frequently asked questions
Is the torn ligament repaired or replaced?+
Replaced. The torn ACL does not hold stitches reliably, so a graft of tendon is used to build a new ligament in its place, secured in tunnels drilled through the bone.
Which graft is best?+
There is no single best graft. Hamstring grafts avoid front-of-knee pain; patellar tendon grafts have a strong track record in high-demand athletes but can cause kneeling discomfort. The right choice depends on your sport, your anatomy and your surgeon's experience.
Is it done by keyhole surgery?+
Yes. ACL reconstruction is performed arthroscopically through small incisions, with an additional small incision to harvest the graft. It is usually a day-care or overnight procedure.
This article is general health information, not medical advice, and it cannot account for your individual circumstances. Please consult a qualified orthopaedic specialist about your own symptoms before making treatment decisions.
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