ACL FAQs

Following are the common questions about ACL:

1. Why is the anterior cruciate ligament important?
2. What is an ACL injury or tear?
3. How do ACL injuries happen?
4. What are the treatment options for ACL injuries?
5. What is ACL reconstruction surgery?
6. Who is a suitable candidate for ACL reconstruction?
7. Can ACL tears heal with time?
8. How soon should I have ACL reconstruction surgery?
9. Can I delay ACL reconstruction surgery?
10. What happens if I don’t get ACL reconstruction surgery?
11. What are the risks associated with an ACL reconstruction surgery?
12. Which graft is most suitable for ACL Reconstruction?
13. Will I require stitches?
14. How long will I have to stay in the hospital after my ACL reconstruction?
15. How successful is ACL reconstruction surgery?
16. What type of rehabilitation would I need after ACL reconstruction surgery?
17. When should I start physiotherapy after ACL reconstruction?
18. Will I have follow-up appointments after an ACL reconstruction?
19. How long does it take to recover from ACL reconstruction surgery?
20. Will I have to wear a knee brace after the surgery?
21. How long would I require crutches to walk?
22. Would I require pain medication after the surgery?
23. When can I resume daily activities after ACL reconstruction surgery?
24. Will I be able to play sports again after ACL Reconstruction Surgery?
25. When can I start driving again after ACL reconstruction surgery?
26. How soon can I resume work after ACL reconstruction surgery?

Q. Why is the anterior cruciate ligament important?

A. The anterior cruciate ligament, or the ACL, is one of the two cruciate ligaments of the knee joint. The ACL is in the front of the joint and runs diagonally. The main function of this ligament is to prevent the tibia (shinbone) from sliding over the femur (thighbone). Additionally, the ACL also provides rotational stability to the joint and prevents over rotation and over-stretching of the knee.

Q. What is an ACL injury or tear?

A. An ACL injury is a sprain or tears in the anterior cruciate ligament. ACL injuries can be classified into three categories based on their severity.

• Grade I: The trauma to the ligament is minor and causes a mild sprain.
• Grade II: The trauma is more severe and some of the fibres from the ligament are torn, resulting in a partial tear.
• Grade III: This is the most severe type of ACL injury and the ligament is completely torn.

Q. How do ACL injuries happen?

A. ACL injuries often happen when your foot is firmly planted and you suddenly change direction, if a solid force hits your knee while landing from a jump, or if you suddenly slow down while running. High-speed twists and extreme extensions of the knee that can cause ACL injuries are quite common in sports like tennis, soccer, basketball, football, etc., which makes sportsmen and athletes specifically vulnerable to ACL injuries.

Q. What are the treatment options for ACL injuries?

A. The treatment of ACL injuries depends on the severity of damage caused to the ligament. Sprains and partial tears can be treated with rehabilitation and physiotherapy programs, and with the help of a knee brace for extra support. A complete tear of the anterior cruciate ligament, however, cannot be treated with conservative methods. To repair the damage caused by the tear and to restore the functioning of the knee, ACL reconstruction surgery is recommended.

Q. What is ACL reconstruction surgery?

A. An ACL reconstruction surgery involves repairing the damaged part of the ACL by replacing it with a soft tissue, which is also called a graft. The surgery promises to restore the stability and strength of the knee joint and is one of the most successful ways of treating total tears of the anterior cruciate ligament.

Q. Who is a suitable candidate for ACL reconstruction?

A. Not everyone who suffers an ACL injury is recommended for ACL reconstruction surgery. Some good candidates for ACL reconstruction surgery include younger individuals, individuals who feel their knee is “giving away”, individuals who have suffered multiple knee injuries or have suffered a total ACL tear, athletes who wish to continue their sport, etc.

Q. Can ACL tears heal with time?

A. While a minor injury or sprain in the anterior cruciate ligament heals with physical therapy, medical attention, and time, the healing capacity of a severe ACL tear is very limited. A fully torn ACL does not “grow back” or repair itself with time. If such an injury is left untreated, the knee joint can become permanently damaged. Moreover, it is a generally observed fact that people with untreated ACL injuries are at a higher risk of arthritis.

Q. How soon should I have ACL reconstruction surgery?

A. It is advisable to undergo surgery as soon as possible after the injury as delaying surgery could cause stiffness in the knee and muscle wasting. However, if you have been diagnosed late and the joint is already stiff, you will have to undergo a few weeks of prehabilitation in preparation for the surgery.

Q. Can I delay ACL reconstruction surgery?

A. ACL reconstruction surgery should be done as soon as possible. Delaying the procedure could cause further damage and degeneration of the knee joint and could lead to stiffness, which can make the surgery more complicated.

Q. What happens if I don't get ACL reconstruction surgery?

A. Choosing not to undergo surgery despite a severe ACL injury could lead to permanent instability and loss of free movement of the knee joint. The anterior cruciate ligament keeps the knee joint stable and facilitates movements like twisting, turning, and changing of direction. A tear of the anterior cruciate ligament, therefore, would result in instability of the knee joint, severe pain, and limited range of movement. The ACL reconstruction surgery aims to repair the damaged and torn part of the ligament with graft and successfully restores the functioning of the knee joint.

Q. What are the risks associated with an ACL reconstruction surgery?

A. Like any other major surgery, ACL reconstruction surgery also has some risks, Some common potential risks and complications may include infections, blood clots, abnormal pain, stiffness in the operated leg, or complications with the anesthesia. There is also the possibility of failure of the graft, re-injury of the operated ligament, and development of osteoarthritis.

It should be kept in mind that the likelihood of these risks depends on the patient's medical history and condition. However, all the risks would be carefully considered and analyzed by your surgeon and the medical team so that a mitigation plan can be made.

Q. Which graft is most suitable for ACL Reconstruction?

A. ACL Reconstruction surgery aims to repair the torn and damaged anterior cruciate ligament with the help of a graft. The graft can be an allograft that is taken from a donor or an autograft, that is taken from the patient. Both types have their own merits and risks. Your surgeon will discuss the type of graft before surgery and explain what graft is more suitable for the procedure.

Q. Will I require stitches?

A. You could get two to three stitches, which are removed within two weeks after the surgery. ACL reconstruction surgery is a minimally invasive procedure. As the procedure is done with an arthroscope, no large incisions are required. This eliminates the need for several stitches.

Q. How long will I have to stay in the hospital after my ACL reconstruction?

A. Typically you can go home the same day or the next day of the surgery. After making sure your vitals are normal, and ensuring that you can at least stand and take a few small steps with support a day after the surgery, your doctor will sanction your discharge. However, if there is a risk of any complication, you may be required to stay for a few extra days.

Q. How successful is ACL reconstruction surgery?

A. ACL reconstruction surgery is successful in over 92 percent of cases. The procedure is highly successful in improving stability, reducing pain, and restoring the range of movement of the knee joint. However, it is crucial to adhere to the rehabilitation programs and follow your doctor’s advice throughout the recovery process to ensure the success of the surgery.

Q. What type of rehabilitation would I need after ACL reconstruction surgery?

A. Your doctor and physiotherapist will formulate your rehabilitation plan for a quick and safe recovery. The plan would include schedules for both follow-up appointments and physical therapy sessions. During physical therapy, your therapist would instruct and guide you through exercises and stretches that would help strengthen and stabilize the knee joint, while your doctor would monitor your progress in the follow-up appointments. The frequency of both will decrease with time as you keep recovering.

Q. When should I start physiotherapy after ACL reconstruction?

A. Physical therapy starts in the hospital immediately after the surgery. Your physiotherapist will guide you to put weight on the operated knee and will help you to stand and take a few steps with crutches. In weeks to come, you would have regular appointments with your physiotherapist, who will help restore the strength, mobility, and stability of the operated joint with exercises and stretches.

Q. Will I have follow-up appointments after an ACL reconstruction?

A. Your doctor will give you a schedule for follow-up appointments at the time of your discharge. The first follow-up would be within two weeks of the surgery, and the doctor would remove your stitches in this visit. The next appointments would be at a two weeks gap, and as you keep recovering, the gap between each appointment would increase.

You shouldn’t skip follow-up appointments as they help the doctor to monitor your progress and detect complications, if any, in time.

Q. How long does it take to recover from ACL reconstruction surgery?

A. It can take about 6 to 8 months to fully recover from ACL reconstruction surgery. You can stand and walk with support almost immediately after the surgery, and you would be able to walk independently within 3 to 4 weeks at max. Once you can walk independently, you can consult with your doctor and ask if you can start driving again. As the timeline for recovery varies from one patient to another, you must talk to your doctor before switching to new types of activities during your recovery period.

Q. Will I have to wear a knee brace after the surgery?

A. Your doctor would advise you to wear a knee brace for at least 3 weeks after the surgery. The use of a brace will provide more support and stability to the knee and would help the recovery process along.

Q. How long would I require crutches to walk?

A. You will need the support of crutches to stand or walk for a few days after the surgery. The rehabilitation and physical therapy program would aim to rid you of crutches in 1 to 2 weeks at max. However, the severity of your injury could extend this period to 4 or 5 weeks.

Q. Would I require pain medication after the surgery?

A. It is normal to experience post-operative pain. You would require pain medication for only 2 to 3 weeks after the surgery. To ease this pain, your doctor can prescribe a combination of light opioids, non-steroidal anti-inflammatory drugs, and local anesthetics.

Q. When can I resume daily activities after ACL reconstruction surgery?

A. Basic activities can be done soon after the discharge. You will be able to stand and put weight on the operated knee a couple of days after the surgery and would be able to take a few small steps with the help of support. You will be able to walk, but you have to be careful to not overwork the knee. Driving can be resumed after six to eight weeks but only after being allowed by your doctor.

Q. Will I be able to play sports again after ACL Reconstruction Surgery?

A. A lot of people who undergo ACL Reconstruction surgery can play light sports. This becomes possible only after several months of structured rehabilitation and physiotherapy. However, it might not be possible to return to heavier, more straining sports, or achieve the previous level of competition.

Q. When can I start driving again after ACL reconstruction surgery?

A. You cannot drive until you can walk properly and independently without crutches. That could take six to eight weeks. You can, however, resume light physical tasks like walking around the house, showering, changing clothes, etc. Once you can walk around easily without help, talk to your doctor and discuss if you can drive again.

Q. How soon can I resume work after ACL reconstruction surgery?

A. You will have to wait for at least six weeks before going back to work. Light office duties can be resumed within 2 to 3 weeks, while moderately demanding tasks should not be done for at least 7 to 8 weeks. If your job requires manual exertion and involves ladders, lifting heavy objects, or standing and walking for extended periods, you should take a break from work for at least 4 months. In any case, it is best to consult with your doctor before returning to work.