ACL reconstruction (Anterior cruciate ligament (ACL) reconstruction)

What is an ACL reconstruction?

The anterior cruciate ligament (ACL) is one of the main ligaments that stabilises the knee, especially during twisting, pivoting and changing direction. It is often torn in sports such as football, rugby, netball and skiing.

A torn ACL usually does not heal back together on its own. In a reconstruction, the surgeon does not simply stitch the torn ends; instead they replace the ligament with a graft — a piece of tendon taken from your own body (commonly the hamstring or kneecap tendon) or, less often, from a donor. The graft is passed through small tunnels in the bone and fixed in place to act as a new ligament.

The main aim is to restore stability so the knee stops giving way, and to allow a return to pivoting sports or physically demanding activity. It is not always necessary: many people, especially those with less demanding lifestyles, do well with a structured physiotherapy programme and no surgery.

Surgery is a bigger commitment than the operation itself, because success depends heavily on months of rehabilitation.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Surgery versus physiotherapy alone

Some people start with physiotherapy and only choose surgery if the knee stays unstable. Your surgeon and physiotherapist can advise.

Preparing for your surgery

• Discuss whether you actually need surgery, based on your sport, work, instability and goals.
• Try to regain a good range of movement and reduce swelling before surgery, as this improves recovery.
• Talk through graft choices and what each means for your recovery and comfort.
• Tell the team about all your health conditions and medicines, including blood thinners.
• Follow fasting instructions for the anaesthetic.
• Arrange a lift home and help for the first days, plus crutches if advised.
• Plan time off work and commit to the physiotherapy programme that follows.

What happens

ACL reconstruction is usually done under a general anaesthetic (asleep), often with a nerve block for pain relief, and sometimes under a spinal anaesthetic. Your anaesthetist will discuss the best choice.

The surgeon takes the chosen graft, then uses keyhole instruments and a camera to prepare the knee. Small tunnels are drilled in the thigh and shin bones, the graft is passed through and fixed in place to replace the torn ligament. Any meniscal or cartilage problems found are treated at the same time. The operation usually takes around one to one and a half hours.

The small cuts are closed and the knee is dressed, sometimes with a brace. Many people go home the same day or after one night, with crutches and a plan to start gentle movement and physiotherapy early.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

Two of the biggest specific risks are the graft re-tearing and an injury to the other knee, especially in young people who return to pivoting sport too soon. A safe return to sport is guided by strength, control and confidence, not just time. Ask your surgeon and physiotherapist how your return will be judged.

Published figures to discuss

Most people regain a stable knee, but figures vary with age, activity, graft choice and how 'success' is measured. The biggest variables are graft re-tear and injury to the other knee, both strongly linked to returning to pivoting sport, especially in younger athletes. The ranges below are cautious and drawn from reviews.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

Recovery from ACL reconstruction is long and depends heavily on your commitment to physiotherapy. The keyhole cuts heal in a couple of weeks, but rebuilding strength, control and confidence in the knee takes many months, and returning to pivoting sport can take up to a year.

• Swelling, stiffness and bruising in the early weeks
• Noticeable thigh muscle weakness that takes months to rebuild
• Needing crutches at first and a brace in some cases
• Tiredness from the effort of rehabilitation
• Slow, staged progress rather than a quick return to sport

Aftercare

• Commit to your physiotherapy programme — your result depends on it.
• Use ice, elevation and pain relief as advised to control swelling.
• Keep the small wounds clean and dry until healed.
• Use crutches and any brace as instructed and follow weight-bearing advice.
• Build up activity in stages and avoid twisting or pivoting until cleared.
• Return to sport only when your physiotherapist confirms you meet the targets.
• Keep follow-up appointments to check progress and the graft.

• Lift home and help for the first few days arranged
• Crutches and any prescribed brace ready
• Ice packs and a way to elevate the leg
• Physiotherapy appointments booked
• Time off work planned (longer for manual jobs)
• Clinic and out-of-hours contact numbers saved

Scars and how they heal

You will have small keyhole scars around the knee and a slightly larger scar where the graft was taken (front of the knee or upper shin). These usually fade over months. Some lasting numbness near the graft-site scar is common because small skin nerves can be crossed. Protecting healing wounds from strong sun helps them settle.

⚠ Get urgent help if…

• Increasing redness, heat, swelling or discharge from the wounds (possible infection)
• A high temperature or feeling generally unwell
• A hot, very swollen, increasingly painful knee (possible joint infection)
• Calf pain, swelling, redness or warmth (possible blood clot)
• Sudden breathlessness or chest pain — call 999, as this may be a clot on the lungs
• The knee suddenly giving way, locking, or severe pain after a twist or fall

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

A good result usually means a stable knee that no longer gives way, allowing a return to most activities and, for many, to pivoting sport. The NHS notes that surgery fully restores knee function in more than 8 in 10 people, though the knee may not feel exactly as it did before the injury and some people have lingering pain or swelling.

Return to sport is judged on strength, control and confidence rather than time alone. Even after a good reconstruction, the graft can re-tear and the other knee is at risk, so a careful, staged return is important to protect both knees.

A well-healed graft can last for many years and let people return to demanding activity. However, the graft can re-tear, particularly in young athletes who return to pivoting sport, and the opposite knee is also at increased risk of an ACL injury. Reviews suggest the graft re-ruptures in a minority of people, and over several years the chance of injuring the other knee can be even higher. A previous ACL injury also raises the long-term risk of knee arthritis, whether or not you have surgery.

Combining with other procedures

ACL reconstruction is often done at the same time as treating other injuries found in the knee, such as a torn meniscus or another damaged ligament. Treating these together can protect the knee, but may lengthen recovery. Your surgeon should explain what else they expect to treat and how it affects your rehabilitation.

Follow-up & long-term care

You will be followed up to check wound healing, movement and progress with physiotherapy, with reviews continuing as you work towards return to sport. Rehabilitation is usually led by a physiotherapist over many months. You should be told who to contact if you have signs of infection, a blood clot, or the knee giving way.

• Keep up strength, balance and control exercises long term
• Follow a graded return-to-sport plan rather than rushing back
• Consider injury-prevention training to protect both knees
• Warm up well and build fitness before returning to pivoting sport
• Report new instability, locking or swelling promptly

Revision and secondary surgery reality

• If the graft re-tears, revision (repeat) reconstruction is more complex, with a longer recovery.
• A previous ACL injury raises the long-term risk of knee arthritis, with or without surgery.
• Persistent stiffness sometimes needs extra physiotherapy or a procedure to free the knee.
• Some people need further surgery for meniscal or cartilage problems over time.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• A structured, progressive physiotherapy programme led by a physiotherapist.
• Return-to-sport decisions based on strength, control and confidence tests.
• A named contact and out-of-hours route for infection or clot symptoms.
• Injury-prevention advice to protect both knees.
• Honest discussion of re-tear risk and long-term joint health.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• The surgeon's fee and the anaesthetist's fee
• Hospital or day-case facility fee and theatre time
• The graft and any fixation devices used
• Treatment of any meniscal or other injuries at the same time
• Physiotherapy and the long rehabilitation programme
• Follow-up appointments and any imaging
• What is covered if a complication or re-tear occurs

• The surgeon's and anaesthetist's fees
• The day-case or overnight facility and theatre
• The graft, fixation devices and any brace
• How many physiotherapy sessions are included
• What happens, and who pays, if a complication or graft re-tear occurs
• The cancellation and rescheduling policy
• Follow-up appointments up to return to sport

On the NHS? ACL reconstruction is available on the NHS when the knee is unstable or symptoms continue despite physiotherapy; private care may be chosen for shorter waits or choice of surgeon.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• Given my sport and lifestyle, do I actually need surgery or could physiotherapy be enough?
• Which graft would you use for me, and why?
• What other injuries in my knee might need treating at the same time?
• How will you decide when I am safe to return to sport?
• What is my personal risk of the graft re-tearing or injuring the other knee?
• What does the rehabilitation involve and how long will it take?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for acl reconstruction

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Knee ligament surgery NHS — Recovering from ACL surgery Return to sport after ACL reconstruction (research update) — PMC Ipsilateral graft and contralateral ACL rupture at five years or more: systematic review — PMC Risk of secondary injury in younger athletes after ACL reconstruction: meta-analysis — PMC

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.