A torn anterior cruciate ligament (ACL) is a serious knee injury that can impact mobility, stability, and overall function. If you’ve been diagnosed with an ACL tear, you may be wondering whether you need ACL reconstruction or ACL repair. While both procedures aim to restore knee function, they differ in approach, recovery time, and long-term outcomes.
This guide from Dr. Manu Bora will help you understand the key differences between ACL reconstruction and ACL repair so you can make an informed decision.
Understanding ACL Injuries
The ACL is one of the major ligaments in the knee, responsible for providing stability and preventing excessive forward movement of the tibia (shin bone) relative to the femur (thigh bone). ACL injuries often occur due to:
- Sudden stops or changes in direction (common in sports like soccer and basketball)
- Direct impact to the knee
- Hyperextension of the knee
- Landing improperly from a jump
Symptoms of an ACL tear include severe pain, swelling, instability, and difficulty bearing weight on the affected leg.
What Is ACL Repair?
ACL repair is a surgical procedure that aims to preserve the existing ligament by reattaching the torn ACL to the bone. This procedure is only suitable in specific cases, such as:
- Partial ACL tears where the ligament remains attached to the bone
- ACL avulsion injuries (where the ligament is torn off the bone rather than torn in the middle)
- ACL tears in young patients with strong healing potential
Pros of ACL Repair
- Preserves the natural ACL tissue
- Shorter recovery time compared to reconstruction
- Less invasive procedure with minimal graft harvesting
- Lower risk of post-surgical stiffness and complications
Cons of ACL Repair
- Limited suitability (not ideal for complete ACL tears)
- Higher risk of re-tear compared to reconstruction
- Long-term durability is still being studied
What Is ACL Reconstruction?
ACL reconstruction is the standard surgical procedure for treating a torn ACL. Instead of repairing the damaged ligament, the surgeon replaces it with a graft. Common graft options include:
- Autograft: Using tissue from your own body (patellar tendon, hamstring tendon, or quadriceps tendon)
- Allograft: Using donor tissue from a cadaver
Pros of ACL Reconstruction
- Suitable for complete ACL tears
- Stronger, more reliable long-term results
- Lower risk of re-injury compared to ACL repair
- Standardized procedure with proven success rates
Cons of ACL Reconstruction
- Longer recovery time (6–12 months before returning to sports)
- Requires graft harvesting, which may lead to additional pain
- Potential risk of graft failure if not properly rehabilitated
| Feature | ACL Repair | ACL Reconstruction |
| Approach | Reattaches torn ACL | Replaces ACL with a graft |
| Suitability | Only for specific cases | Suitable for complete ACL tears |
| Recovery Time | 3–6 months | 6–12 months |
| Risk of Re-tear | Higher | Lower |
| Invasiveness | Less invasive | More invasive |
| Long-term Durability | Still being studied | Well-established |
Key Differences Between ACL Repair and ReconstructionHow to Decide Between ACL Repair and ACL Reconstruction
Your choice between ACL repair and reconstruction will depend on several factors:
- Extent of the Injury: If your ACL is completely torn, reconstruction is the better option. If it’s a partial tear, repair may be possible.
- Age and Activity Level: Younger, more active individuals, especially athletes, may benefit more from ACL reconstruction due to its durability.
- Healing Potential: Some individuals may not be good candidates for ACL repair due to poor tissue quality or other underlying conditions.
- Recovery Goals: If you want a quicker return to daily activities and sports, ACL repair might be appealing, but it comes with a higher risk of re-injury.
- Surgeon’s Recommendation: Consulting with an experienced orthopedic surgeon can help determine the best approach based on your specific condition.
Recovery and Rehabilitation
Regardless of the procedure, rehabilitation plays a crucial role in ensuring a successful outcome.
ACL Repair Recovery Timeline
- First 4 Weeks: Limited weight-bearing, use of crutches, physical therapy begins
- 2–3 Months: Strengthening exercises, gradual return to activities
- 4–6 Months: Return to low-impact sports, continued rehab
ACL Reconstruction Recovery Timeline
- First 6 Weeks: Strict physical therapy, limited weight-bearing
- 3–6 Months: Progressive strengthening, light jogging
- 6–12 Months: Return to high-impact sports (depending on progress and clearance from the doctor)
Conclusion: Which Procedure Is Right for You?
Both ACL repair and ACL reconstruction have their pros and cons, but the best choice depends on the severity of your injury, your lifestyle, and your long-term goals. If you have a minor or partial tear, ACL repair may be an option. However, for complete ACL tears, reconstruction remains the gold standard for long-term knee stability.
Always consult an orthopedic specialist to evaluate your condition and recommend the best course of action. Proper treatment and rehabilitation can help you regain full knee function and prevent future injuries.
You can consult Threads Physio by Dr. Manu Bora regarding ACL or any other injury.