Introduction

The anterior cruciate ligament, or ACL, is a key band of tissue inside the knee joint that helps stabilise the knee and allows smooth movement. Injuries to this ligament are common, especially among active people and athletes, and can cause pain, instability, and difficulties with everyday activities. ACL repair is a surgical option often recommended to fix these injuries, aiming to restore stability and function to the knee. This guide is for anyone who has been diagnosed with an ACL injury or is considering ACL repair surgery. We’ll explore whether ACL repair is considered major surgery, explain what the operation involves, and outline what you can expect before, during, and after the procedure.

What Makes ACL Repair a Major Surgical Procedure?

In orthopaedics, surgeries are often described as ‘major’ or ‘minor’ based on what part of the body is involved, how complex the procedure is, the anaesthesia needed, and the recovery process. ACL repair is classed as major surgery because it involves working on an important structure inside the knee, which is essential for joint stability. The ACL connects your thigh bone (femur) to your shin bone (tibia) and stops the tibia from moving too far forwards. When the ACL tears, your knee can feel unstable and be more likely to give way. Fixing the ligament is a delicate task because of where it sits and its job. There are two main surgical methods: repairing the torn ligament by stitching it back together, or reconstructing it by replacing the damaged ligament with a graft from another tendon. Both surgeries need expert surgeons with special skills. As noted by Vavken and Murray (2011), “the objective of this work is to assess the feasibility of successfully repairing the torn ACL.” Experts like Professor Paul Lee and the team at MSK Doctors have vast experience in managing ACL injuries and provide patient-focused care tailored to individual needs.

What Happens During ACL Repair Surgery?

On the day of your surgery, you’ll undergo a full pre-operative check and preparation. You’ll meet the surgical and anaesthetic teams who will explain the procedure and answer any last-minute questions. ACL repair usually requires general anaesthesia – so you’ll be asleep during the operation – sometimes combined with a nerve block to reduce pain afterward. The surgery typically takes between one and two hours. The procedure is performed arthroscopically, which means your surgeon will make a few small cuts around your knee and use a tiny camera to see inside the joint. They then carefully repair the torn ligament, sometimes using special stitches or devices to hold it in place while it heals. Though the surgical techniques are minimally invasive, ACL repair is a complex operation that demands precision and a clean, controlled environment. Afterward, you’ll typically stay in hospital for several hours or overnight so the medical team can manage your pain and monitor your recovery closely.

Risks, Possible Complications and Recovery Expectations

Like all major surgery, ACL repair involves certain risks. Some post-operative pain is normal and can be managed with medication and physiotherapy. Possible complications include infection, stiffness in the knee, failure of the repair to heal properly, or slower recovery than expected. However, if the repair does not succeed, one “main advantage is that all graft options remain available for future surgery” (Fradin et al., 2021), which is reassuring when planning treatment options. Research reminds us that the structural strength of the repaired ligament is key to long-term joint health. Beveridge et al. (2019) found “inferior ACL structural properties may inadequately restrain joint motion after surgery, contributing to the risk of post-traumatic osteoarthritis.” Their study suggests that “techniques that provide higher stiffness to the repaired ACL may help reduce the arthritis risk commonly seen after ACL injury.” Further advances aim to improve natural healing. Vavken and Murray (2011) highlight that “a main barrier to intrinsic ACL healing is the lack of blood clot formation between the torn ligament ends.” New biological scaffolds show encouraging results in animal studies, “suggesting potential for successful future clinical use.” Recovery includes early and ongoing physiotherapy focused on restoring strength, mobility and function. The care and experience offered by specialists such as Professor Lee and MSK Doctors help patients through this crucial phase and improve outcomes.

How to Prepare and Support Your Recovery

Preparing for ACL repair goes beyond the operating day. Arrange for time off work or daily tasks, plan your physiotherapy schedule, and modify your home to make moving around safer and easier during recovery. Communicate openly with your healthcare team and follow their advice carefully – from medications to wound care and activity limits. Taking an active role in your recovery matters. Providers like MSK Doctors offer valuable resources such as counselling and rehabilitation support. While no operation guarantees perfect results, being prepared and engaged boosts your chances of a positive outcome.

Common Patient Questions About ACL Repair

How long does recovery take?
Individual recovery varies, but most patients can gradually return to regular activities over several months with committed physiotherapy. What are the most serious risks?
Infection, graft failure, stiffness, and a risk of osteoarthritis linked to ligament stiffness have been noted. Can complications be avoided?
Following your surgical and rehab plan diligently, as well as regular medical check-ups, can greatly reduce risks. What can I do to improve my chances of success?
Stick to your rehabilitation, maintain communication with your healthcare team, and care for your overall health. Will I regain full function?
Many people recover excellent knee function, but results depend on injury severity and rehabilitation dedication.

Conclusion

ACL repair is a significant and well-established surgical procedure that requires expert surgical skill, thorough preparation, and committed rehabilitation to achieve the best results. If you are considering ACL repair, seek advice from specialists with extensive experience like Professor Paul Lee and the MSK Doctors team, who provide expert and personalised care every step of the way. For personalised medical advice, always consult a qualified healthcare professional.

References

• Fradin, T., Haidar, I., Rayes, J., Ngbilo, C., Dutra Vieira, T., & Sonnery‐Cottet, B. (2021). Arthroscopic ACL Reconstruction After Failed ACL Repair. Arthroscopy Techniques, 10(4), e1001-e1005. https://doi.org/10.1016/j.eats.2020.11.022
• Vavken, P., & Murray, M. M. (2011). The Potential for Primary Repair of the ACL. Sports Medicine and Arthroscopy Review, 19(1), 44-49. https://doi.org/10.1097/jsa.0b013e3182095e5d
• Beveridge, J.E., Proffen, B.L., Karamchedu, N.P., Chin, K.E., Sieker, J.T., Badger, G.J., Kiapour, A.M., Murray, M.M., & Fleming, B.C. (2019). Cartilage Damage Is Related to ACL Stiffness in a Porcine Model of ACL Repair. Journal of Orthopaedic Research, 37(10), 2249–2257. https://doi.org/10.1002/jor.24381