ACL Tear — Arthroscopic ACL Reconstruction
A knee that gives way when you turn is not something to train through — every episode of instability damages the cartilage further. Our sports surgeons reconstruct the ligament arthroscopically with your own tendon graft, through keyhole incisions. Home the next day, walking within two weeks, and back to sport at nine to twelve months with proper rehabilitation.
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What is ACL Tear?
The anterior cruciate ligament runs diagonally through the centre of the knee, connecting the thigh bone to the shin bone. Its job is to stop the shin sliding forwards on the thigh and to control rotation. It is what allows you to plant a foot and turn without the knee collapsing.
Most ACL tears happen without any contact at all. The classic mechanism is a sudden deceleration, a pivot or an awkward landing — the foot is planted, the body rotates, and the ligament fails. Many people describe hearing or feeling a distinct "pop", followed by the knee swelling substantially within a few hours. That rapid swelling is haemarthrosis, bleeding into the joint, and it is one of the most reliable clinical signs of a significant internal injury.
A torn ACL does not heal by itself. The ligament has a poor blood supply, and once ruptured the two ends retract and scar separately. This is why the treatment is called reconstruction rather than repair: the torn ligament is removed and replaced with a graft, usually a tendon taken from elsewhere in your own knee — the hamstring tendons, or a strip of the patellar or quadriceps tendon.
Here is the part that surprises many patients: not everyone with an ACL tear needs surgery. The ACL matters most for pivoting, cutting and landing. Someone whose activity is walking, cycling, swimming and straight-line running may cope well with a structured strengthening programme and never need an operation. The decision depends on your age, your activity level, your occupation, and — most of all — whether the knee gives way in daily life. A knee that buckles when you turn on a staircase needs fixing regardless of whether you play sport.
What tips the balance towards surgery is instability and what it does over time. Each giving-way episode risks tearing the meniscus and damaging the cartilage, and that damage accumulates into early arthritis. A young, active person with a genuinely unstable knee is generally better served by reconstruction than by living with it.
One more point, and it is the one that most determines your result: the operation is perhaps a third of the treatment. The other two-thirds is rehabilitation over six to nine months — and it starts before surgery. "Prehabilitation", getting the swelling down and the quadriceps working before the operation, measurably improves the final outcome. Reconstructing a stiff, swollen, weak knee gives a worse result than waiting a few weeks and doing it properly.
Treatment information
| Condition | Anterior Cruciate Ligament (ACL) Tear |
|---|---|
| Procedure | Arthroscopic ACL Reconstruction |
| Duration | 60 to 90 minutes |
| Treated by | Orthopaedic / Sports Injury Surgeon |
| Anaesthesia | Spinal anaesthesia, often with a nerve block |
| Success rate | 85–95% return to sport |
| Recovery time | 6 to 9 months for sport; 2 to 3 weeks for daily activity |
| Hospital stay | Daycare to 1 day |
Signs you may need ACL Tear treatment
- A distinct pop or snap felt or heard at the moment of injury
- Rapid swelling of the knee within a few hours, from bleeding into the joint
- Severe pain at the time, which often settles substantially within days
- Inability to continue playing or to bear weight comfortably
- A sense that the knee is loose, unstable or 'not connected'
- The knee giving way when turning, pivoting or changing direction
- Difficulty with stairs, especially coming down
- Reduced range of movement while the knee is swollen
- Locking or catching, which suggests an associated meniscal tear
- Loss of confidence in the knee, and unconsciously avoiding turning on it
- Wasting of the thigh muscle within weeks of the injury
What causes it?
- Sudden deceleration or a change of direction with the foot planted
- Landing awkwardly from a jump, particularly with the knee collapsing inwards
- Pivoting on a fixed foot — the classic football, kabaddi, basketball and badminton mechanism
- A direct blow to the outside of the knee, forcing it inwards
- Hyperextension of the knee
- Road traffic accidents and falls from height
- Poor landing mechanics and weak hip and core muscles, which allow the knee to collapse inward
Who is more likely to be affected
- Playing pivoting sports — football, basketball, kabaddi, badminton, skiing
- Female sex, with a several-fold higher risk related to anatomy, hormones and landing mechanics
- Weak hamstrings relative to quadriceps, and weak hip abductors
- Poor neuromuscular control, particularly knee valgus collapse on landing
- A previous ACL injury in either knee
- Playing on artificial turf or in inappropriate footwear
- Inadequate warm-up and returning to sport before full rehabilitation
- A family history of ligament laxity
When to see a doctor immediately
- Any knee injury followed by a pop and rapid swelling within hours
- A knee that gives way or buckles during normal activity
- Inability to fully straighten or bend the knee after an injury
- Locking or catching within the joint
- Persistent instability weeks after an injury that seemed to settle
- Thigh muscle wasting after a knee injury
- Inability to bear weight after a knee injury — this needs assessment to exclude a fracture
- Recurrent giving-way, even if pain has resolved — this is the pattern that damages cartilage over time
How it is diagnosed
Clinical examination
The Lachman test, anterior drawer and pivot shift assess the front-to-back and rotational stability of the knee. In experienced hands the Lachman test is highly accurate, and a skilled examination frequently makes the diagnosis before any scan. Examination is easier once the initial swelling and guarding have settled.
X-rays
Do not show the ligament, but exclude fractures and detect a Segond fracture — a small avulsion at the outer edge of the tibia that is strongly associated with ACL rupture. Also assesses the growth plates in adolescents, which changes the surgical technique.
MRI scan
The definitive investigation. It confirms the ACL tear, grades it as partial or complete, and — just as importantly — identifies the associated injuries that are present in a majority of cases: meniscal tears, cartilage damage, bone bruising and other ligament injuries. The whole surgical plan depends on what else it finds.
Assessment of the meniscus and other ligaments
A specific examination for medial and lateral collateral ligament injury, posterior cruciate involvement and meniscal tears. A missed associated injury is a common reason for a poor result after an otherwise technically good reconstruction.
Functional and activity assessment
A structured discussion of your sport, occupation and goals, since these drive the decision far more than the MRI does. A recreational cyclist and a competitive kabaddi player with identical scans may reasonably choose different treatments.
Pre-operative physiotherapy assessment
Range of movement, swelling and quadriceps activation are measured before surgery. Operating on a knee that is still swollen and stiff produces worse outcomes, so this assessment often sets the date rather than the calendar doing so.
How the options compare
| Feature | Hamstring Tendon Graft | Patellar Tendon (BTB) Graft |
|---|---|---|
| Graft source | Semitendinosus and gracilis tendons | Middle third of patellar tendon with bone blocks |
| Healing in the tunnel | Tendon-to-bone — slower | Bone-to-bone — faster and more secure |
| Anterior knee pain afterwards | Less common | More common |
| Kneeling comfort | Better | Often uncomfortable |
| Graft rupture rate | Slightly higher in young pivoting athletes | Slightly lower |
| Hamstring strength | Mild long-term deficit possible | Preserved |
| Donor site problems | Minimal | Patellar tendon and kneecap issues possible |
| Commonly chosen for | Most recreational athletes; those who kneel at work | Elite and pivoting-sport athletes |
Types of treatment
Non-surgical management
Structured rehabilitation alone
A genuine option for older or less active patients, for those whose activities are straight-line rather than pivoting, and for partial tears with a stable knee. A strong, well-controlled knee can compensate substantially for a deficient ACL. It requires commitment to a proper programme, not simply avoiding surgery.
Activity modification
Swapping pivoting sports for cycling, swimming, straight-line running and gym work. Effective and appropriate for many patients, though it is a real change and should be discussed honestly rather than presented as equivalent.
Functional bracing
A hinged brace can give confidence and some protection during activity. The evidence that it prevents further giving-way episodes is limited, so it supports a decision rather than substituting for one.
Prehabilitation
Not an alternative to surgery but a prerequisite for it. Reducing swelling, restoring full straightening and reactivating the quadriceps before the operation measurably improves the final outcome and reduces post-operative stiffness.
Surgical reconstruction
Arthroscopic ACL reconstruction with hamstring graft
The most commonly performed technique. The semitendinosus and gracilis tendons are harvested through a small incision, folded into a multi-strand graft, and passed through tunnels drilled in the femur and tibia along the path of the original ligament. Low donor-site morbidity and good kneeling comfort.
Bone-patellar tendon-bone (BTB) reconstruction
The middle third of the patellar tendon with a block of bone at each end. Bone-to-bone healing in the tunnels is faster and very secure, and graft rupture rates are marginally lower — which is why it is often preferred for elite and pivoting-sport athletes. The trade-off is a higher rate of anterior knee pain and discomfort when kneeling.
Quadriceps tendon graft
A strong graft with a growing evidence base and less anterior knee pain than BTB. Increasingly used both for primary reconstruction and for revision surgery.
Meniscal repair at the same sitting
Meniscal tears accompany a large proportion of ACL injuries. Repairing rather than trimming the meniscus preserves the cartilage cushion and meaningfully reduces the long-term arthritis risk — but it lengthens the rehabilitation, often with restricted weight-bearing for several weeks.
Lateral extra-articular tenodesis
An additional procedure on the outer side of the knee that reduces rotational instability. Added for patients at high risk of graft failure — young pivoting athletes, revision cases and those with marked generalised laxity.
Revision ACL reconstruction
For a failed previous reconstruction. More complex, sometimes requiring bone grafting of old tunnels in a first stage, with less predictable results than primary surgery.
What happens, step by step
- 1
Assessment and decision
40–60 minutes- Clinical examination including Lachman and pivot shift tests
- MRI reviewed for the ACL and, critically, for associated meniscal and cartilage injury
- An honest discussion of whether surgery is needed at all, based on your activity and instability
- Graft choice discussed with the trade-offs of each explained
- 2
Prehabilitation
2 to 6 weeks- Swelling reduced with ice, compression and elevation
- Full knee straightening restored before surgery — this prevents post-operative stiffness
- Quadriceps activation and strengthening begun
- Surgery scheduled when the knee is calm rather than on a fixed date
- Blood tests, ECG and anaesthetic assessment completed
- 3
The reconstruction
60–90 minutes- Spinal anaesthesia with a nerve block for post-operative comfort
- Arthroscopy through two small portals inspects the whole joint
- Meniscal tears are repaired or trimmed as found
- The graft is harvested and prepared to the required diameter
- Tunnels are drilled in the femur and tibia along the original ligament's anatomical path
- The graft is passed, tensioned and fixed with suspensory devices or interference screws
- Stability is tested through the full range before closure
- 4
Early recovery
Day 0 to Day 2- Straight-leg raises and ankle pumps begin the same day
- Weight-bearing with crutches, as allowed — usually full unless a meniscus was repaired
- Ice and elevation to control swelling
- Discharge the same day or the next morning
- The rehabilitation protocol is issued in writing and the first physiotherapy appointment booked
How to prepare
- Do the prehabilitation properly — a calm, straight, strong knee before surgery gives a better knee after it
- Get the swelling down and restore full extension before the operation date
- Discuss graft choice in advance, especially if your work or worship involves kneeling
- Arrange your physiotherapy for the whole six to nine months, and budget for it, before you start
- Complete blood tests, ECG and anaesthetic assessment
- Stop smoking — it impairs graft incorporation and healing
- Fast for six to eight hours before the procedure
- Arrange crutches, ice packs and a brace in advance if your surgeon has prescribed them
- Prepare your home for crutches: clear floors, and a plan for stairs
Why patients choose this procedure
The knee stops giving way
Restoring the ligament restores rotational control. The buckling that made stairs, turning and uneven ground unpredictable resolves.
Protects the meniscus and cartilage
Every giving-way episode risks new meniscal and cartilage damage. Stabilising the knee stops that accumulation, which is the main long-term argument for surgery in an active person.
Return to pivoting sport
With a proper rehabilitation programme, 85 to 95% of patients return to sport, and a substantial proportion to their previous level.
Keyhole surgery
The reconstruction is done arthroscopically through two small portals plus a short incision for the graft. Less pain and faster early recovery than open surgery.
Uses your own tissue
An autograft from your own hamstring, patellar or quadriceps tendon incorporates into the bone tunnels over months and becomes living tissue, with no rejection risk.
Confidence returns
The psychological element is real and often underestimated. Trusting the knee again is a large part of getting back to sport, and structured rehabilitation rebuilds it deliberately.
Possible risks and side effects
Graft failure or re-rupture
Occurs in roughly 5 to 10%, and considerably more in young athletes who return to pivoting sport early. Returning before nine months and before passing objective strength tests is the single biggest avoidable risk factor.
Stiffness and loss of extension
The most common complication and the most preventable. It is why prehabilitation and early emphasis on full straightening matter so much. A knee that will not fully straighten causes a permanent limp and ongoing pain.
Persistent quadriceps weakness
Very common and frequently the real reason someone does not get back to sport. It needs months of targeted work, and objective strength testing rather than a subjective sense of readiness.
Infection
Uncommon after arthroscopic surgery, but serious when it involves the graft. Increasing pain, fever, spreading redness or discharge must be reported without delay.
Deep vein thrombosis
A recognised risk after lower limb surgery, reduced by early mobilisation, ankle exercises and, where indicated, blood thinners.
Anterior knee pain and difficulty kneeling
More common after patellar tendon grafts. Worth weighing in advance if your work, prayer or daily routine involves kneeling.
Numbness below the incision
A small sensory nerve is frequently affected during hamstring graft harvest, leaving a patch of numbness on the outer side of the shin. Common, harmless and often permanent.
Growth plate injury in adolescents
A specific concern in skeletally immature patients. Modified techniques that avoid the growth plates are used, and surgery is sometimes deferred until growth is complete.
What recovery looks like
ACL rehabilitation is long, and it is the part that decides your result. The surgery reconstructs the ligament; the following nine months determine whether you get a knee you can trust. The graft is at its weakest between roughly six weeks and three months, as it remodels — which is precisely when patients feel good and are most tempted to do too much.
Weeks 0 to 2: control swelling with ice, compression and elevation. The priority is full extension — getting the knee completely straight, which is more important at this stage than bending it. Quadriceps activation, straight-leg raises and ankle pumps from day one. Weight-bearing with crutches as allowed; restricted for longer if a meniscus was repaired.
Weeks 2 to 6: crutches are discarded as the gait normalises. Bend progresses towards 120 degrees. Stationary cycling begins. The focus is quadriceps strength and a normal walking pattern — limping that is allowed to persist becomes a habit that takes months to unlearn.
Weeks 6 to 12: full range of movement. Progressive strengthening of quadriceps, hamstrings, hips and core. Swimming and cycling are excellent now. The knee feels good, and this is the most dangerous phase: the graft is biologically weak while feeling strong. Follow the protocol, not your confidence.
Months 3 to 6: strength work intensifies, with balance and proprioception training. Straight-line jogging usually begins around month four to five, once strength targets are met — not at a fixed date. Agility drills, gradual and controlled, follow.
Months 6 to 9: sport-specific training, cutting, pivoting and jump-landing mechanics. Objective testing — hop tests and isokinetic strength measurement — determines readiness. The usual benchmark is quadriceps strength within 10% of the other leg.
Months 9 to 12: return to competitive pivoting sport, once objective criteria are met. Returning before nine months substantially raises the re-rupture risk, and this is where patience genuinely pays.
Contact your care coordinator immediately for fever, increasing pain, spreading redness, discharge, calf pain or swelling, breathlessness, or the knee giving way after surgery.
What to eat and what to avoid
Recommended
- Protein at every meal — muscle rebuilding is the whole rehabilitation, and it needs the raw material
- Vitamin C from amla, guava and citrus, essential for collagen in the healing graft
- Calcium and vitamin D for bone healing in the tunnels
- Omega-3 sources such as fish, walnuts and flaxseed
- Iron-rich foods to recover after surgical blood loss
- Green leafy vegetables and a wide range of coloured fruit
- 2 to 3 litres of water daily
Best avoided
- Smoking and nicotine, which measurably impair graft incorporation into bone
- Alcohol, which interferes with muscle protein synthesis and sleep quality
- Excess weight gain during a long low-activity period
- Refined sugar and heavily processed food
- Crash dieting during rehabilitation — inadequate protein directly limits muscle recovery
- Unregulated supplements and steroids marketed for faster recovery
Post-operative care, at no extra cost
- Diet and lifestyle consultation with a nutritionist
- Scheduled follow-up calls until you are fully recovered
- Free cab for the follow-up visit
- 24×7 access to your care coordinator for any concern
ACL Tear treatment cost
₹1,20,000 – ₹2,80,000
The range depends on the graft used, whether a meniscus repair or another ligament reconstruction is done at the same time, the implants used for fixation, your city, the hospital and your room category. Physiotherapy over the following six to nine months is a real and substantial cost that is frequently underestimated — ask about it at the start, because the rehabilitation matters as much as the operation. ACL reconstruction after a documented injury is covered by most health insurance policies; our insurance desk verifies eligibility before admission.
Inside the care journey
ACL Tear — your questions answered
No. The ACL matters most for pivoting, cutting and landing. If your activities are walking, cycling, swimming or straight-line running, and your knee does not give way in daily life, a structured strengthening programme may serve you well without surgery. What pushes towards reconstruction is genuine instability — a knee that buckles — and a young, active life ahead, because repeated giving-way episodes damage the meniscus and cartilage and lead to early arthritis.