KNEE SURGERY GLASGOW
ACL Reconstruction
What is an ACL reconstruction?
The anterior cruciate ligament (ACL) is one of the main stabilising ligaments of the knee. When it is torn, the knee can feel unstable, especially during twisting or pivoting movements.
ACL reconstruction is an operation to replace the torn ligament with a graft, usually taken from your own hamstring, patellar tendon or quadriceps tendon. The graft provides stability in the knee and with healing and careful strengthening, it can allow an athlete to have a stable knee again.
Why might I need an ACL reconstruction?
You may be offered ACL reconstruction if:
Your knee gives way during daily or sporting activities
You wish to return to sports that involve pivoting, cutting, or sudden changes in direction (e.g. football, rugby, skiing)
You have associated injuries, such as meniscal tears, that need stabilisation
Your knee feels persistently unstable despite rehabilitation
Not every ACL injury needs surgery — some people manage well with physiotherapy and activity modification.
What does ACL surgery involve?
The procedure is usually performed under a general anaesthetic and takes around 1–2 hours.
Small keyhole incisions are made around the knee.
The torn ACL is removed and replaced with a graft (commonly hamstring or patellar tendon).
The graft is fixed in place with special screws or fixation devices.
You usually go home the same day or after an overnight stay.
What will the recovery be like after surgery?
Rehabilitation is the most important part of recovery after ACL surgery.
Early phase (first weeks): focus on reducing pain and swelling, regaining knee movement, and starting muscle activation. Cryotherapy and gentle exercises are helpful.
Progressive strengthening: exercises for quadriceps, hamstrings, and hip/core stability. Early weight-bearing and movement are encouraged.
Running: usually permitted from around 3–4 months, provided you have good strength, no swelling, and near-normal movement.
Return to sport: typically 9–12 months, depending on progress, sport demands, and meeting specific criteria for strength, stability, and confidence.
Every patient’s timeline is individual and guided by progress rather than just time after surgery.
What are the risks of surgery?
All operations carry some risks. Specific risks of ACL reconstruction include:
Pain, swelling, or stiffness in the knee
Infection (rare, <1%)
Blood clots (deep vein thrombosis)
Graft failure (the new ligament may stretch or tear again)
Numbness around the scar
Persistent instability despite surgery
Very rarely, damage to nerves or blood vessels
Are there alternatives to surgery?
Not all ACL injuries require reconstruction. Alternatives include:
Physiotherapy-led rehabilitation: focused on strengthening and stability training, which may allow some patients to function well without surgery
Activity modification: avoiding high-risk pivoting or contact sports
Bracing: may be used in certain cases for support
For patients with lower activity demands, non-surgical management can be effective. However, for young or active individuals wishing to return to pivoting sports, reconstruction is usually the best option.
