How does ACL reconstruction work?

Before surgery, the knee is assessed with a physical examination and may be evaluated with a musculoskeletal MRI. The team considers swelling, movement, activity goals and any associated meniscus or cartilage injury. Prehabilitation may be recommended to improve movement and prepare the muscles around the knee.

During the operation, an arthroscope lets the surgeon view the joint through small incisions. The damaged ligament is addressed, tunnels are prepared in the thigh and shin bones, and a selected graft—such as a quadriceps tendon graft—is passed through and fixed in the ACL’s position. The graft acts as a framework while the body incorporates it.

Early rehabilitation focuses on controlling swelling, regaining knee straightening, waking up the quadriceps and walking safely. Later work develops strength, balance, landing control and confidence. Post-operative rehabilitation is adjusted to healing, examination findings and the demands of work or sport.

Progress is based on function rather than a calendar alone. A return-to-sport programme may add running, changes of direction and sport-specific drills in stages. Follow the surgical team’s instructions about wound care, weight-bearing, driving and exercise, and report concerns rather than pushing through a new problem.

Contact the surgical team promptly for increasing redness or drainage at an incision, fever, worsening calf pain or swelling, new shortness of breath, a locked knee, or a sudden loss of movement. Urgent help is needed for chest pain or difficulty breathing. A new giving-way episode or a pop during rehabilitation should also be reported before activity is advanced.

Ask which graft suits your goals, what other knee damage was found, and what restrictions apply at each stage. Clarify the rehabilitation milestones, how progress will be tested, when driving and work may be considered, and which symptoms require an urgent call.