ACL Reconstruction: A Guide for Active Adelaideans
Few sporting injuries produce that sinking feeling quite like an ACL tear. Maybe you’ve heard a pop, felt your knee give way underneath, or known immediately that something wasn’t right. Or perhaps the injury crept up more slowly, with persistent instability that makes you hesitant on uneven ground or during quick changes of direction.
ACL injuries are common, particularly in sports that involve pivoting, jumping and sudden stops. Think of sports like soccer, AFL, netball, basketball, and skiing. These injuries can affect anyone from competitive athletes to weekend warriors.
Not every ACL tear requires surgery. But when it does, understanding what reconstruction involves can help you approach the process with confidence.
What is the ACL and what does it do?
The anterior cruciate ligament (ACL) runs diagonally through the centre of the knee, connecting the femur (thigh bone) to the tibia (shin bone). Its primary job is to control rotational movement and prevent the tibia from sliding too far forward relative to the femur. When the ACL is torn, the knee can feel unstable, particularly during activities that involve rotation or pivoting.
Do I need surgery?
Not every person with an ACL tear needs reconstruction. Some people, particularly those with lower activity demands and a stable knee, can manage well with physiotherapy and rehabilitation alone.
Surgery tends to be recommended when:
- The knee continues to feel unstable despite rehabilitation
- You want to return to sport that involves pivoting or cutting movements
- There is associated damage to the meniscus or other structures that also needs addressing
- You are young and active, and long-term knee stability is a priority
The decision should be made in discussion with an orthopaedic surgeon who understands your lifestyle, goals, and the full picture of your knee condition.
What does ACL reconstruction involve?
ACL reconstruction replaces the torn ligament with a graft, usually tissue taken from your own body (an autograft). Common graft options include the hamstring tendons or the patellar tendon. The procedure is typically performed arthroscopically, meaning through small incisions using a camera and instruments, rather than through a large open cut.
The graft is threaded through tunnels drilled in the femur and tibia and secured in position. Over time, through a biological process called ligamentisation, the graft gradually integrates and takes on the properties of a ligament.
In addition to hamstring and patellar tendon grafts, a quadriceps tendon graft may be considered for ACL reconstruction. In certain cases, a peroneal tendon graft, most commonly taken from the peroneus longus tendon near the outer ankle, may also be discussed as an alternative graft source. Because this involves harvesting tissue from the ankle region, potential donor-site considerations should form part of the surgical discussion.
For patients with higher rotational instability or a greater risk of graft reinjury, an additional procedure called lateral extra-articular tenodesis (LET) may be performed alongside ACL reconstruction. LET is intended to provide additional control of twisting movements through the knee, and clinical research in young, active patients at higher risk of reinjury has reported lower graft rupture rates when LET is added to hamstring tendon ACL reconstruction. The most suitable graft choice and the role of LET are determined after assessment of the injury, knee stability, sporting demands and individual circumstances.
What is the recovery like?
ACL reconstruction is one of the longer orthopaedic recoveries, and that is worth being clear about upfront. The operation itself typically takes around an hour and is done as a day procedure or with a one-night stay. The bigger commitment is rehabilitation.
A typical recovery timeline looks something like this:
- Weeks 1 to 2: Managing swelling and pain, gentle range of motion exercises, walking with crutches
- Weeks 3 to 6: Progressive weight-bearing, building quadriceps and hamstring strength
- Months 2 to 4: More demanding strength and stability exercises, light jogging if milestones are met
- Months 4 to 6: Running, sport-specific drills, agility work
- Months 9 to 12: Return to full competitive sport, depending on strength, stability and psychological readiness
Returning to sport too early is a significant risk factor for re-injury. Your surgeon and physiotherapist will guide your return based on objective criteria rather than time alone.
What about the meniscus?
ACL tears frequently occur alongside meniscal injuries. If a meniscus tear is present, your surgeon will assess whether it can be repaired (preserved) or whether part of it needs to be trimmed. Wherever possible, preservation is preferred, as the meniscus plays an important protective role in the knee.
If you have had a knee injury and want an expert assessment, ask your GP for a referral to Dr David Kitchen, or call 8130 1228.
* This article provides general information only and is not a substitute for professional medical advice, diagnosis or treatment. Dr David Kitchen (MED0001951664), MBBS MA (Cantab) BA Hons PhD FRACS FAOrthA, is an Orthopaedic Specialist Surgeon in Adelaide, Australia. Any surgical or invasive procedure carries risks. Individual results, recovery timeframes and suitability for treatment vary. Always seek advice from your GP, specialist or qualified health professional about your own medical condition.
References
Getgood, A., Hewison, C., Bryant, D., et al. (2020). Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft anterior cruciate ligament reconstruction: 2-year outcomes from the STABILITY Study randomized clinical trial. American Journal of Sports Medicine, 48(2), 285–297.
Quinn, M., et al. (2024). Peroneus longus tendon autograft may present a viable alternative for anterior cruciate ligament reconstruction: A systematic review.
American Academy of Orthopaedic Surgeons. (2022). Management of anterior cruciate ligament injuries: Evidence-based clinical practice guideline.