ACL RECONSTRUCTION & GRAFT CHOICE
The graft is the new ligament that replaces your torn ACL.
We individualise the choice based on your age, sport, body type, knee anatomy, occupation, and what matters most to you (kneeling, sprint speed, hamstring strength). The right answer for a 17-year-old netballer is different to the right answer for a 38-year-old recreational skier.
ACL RECONSTRUCTION
INFORMATION
Days 0 to 14
Immediate post-surgery care is about wound healing and swelling management. You will be able to go home the same day as surgery. You will be allowed to partial weight bear with the help of crutches, placing 20 to 50% of your body weight based on instructions by your surgeon after the surgery. You will be in a knee brace for total of 2 to 5 weeks, to be worn when mobilising / weight bearing. You can remove your brace for exercises and simply to rest. It is a good idea to wear a brace while sleeping for the first week. Regular icing along with compression 3 to 5 minutes every half an hour is recommended.
Leave your waterproof dressings on until your review in clinic 10-14 days post-surgery. You can shower with your waterproof dressings on.
EXERCISES
• Knee extension – ensure your knee comes out fully straight in the first two weeks
• Aim to bend your knee to 90 degrees and work on quads activation
• Follow the exercise program as per the hospital physiotherapy team
Week 2 Onwards
Progress with your knee range of motion and quadriceps strengthening exercises. You can commence physiotherapy at 2 weeks.
Full weight bearing will be allowed between 2 and 5 weeks as per your surgeon’s instructions. Ensure you are only wearing a brace when mobilising. Cycling will be allowed as soon as you are full weight bearing.
You can consider returning to desk duties if clearance given around 4 weeks.
4 Months Onwards
If your quads are ready, you can commence running at 4 months, sport specific training at 9 months, and return to sports at 12 MONTHS at the earliest. For each progression event, consult your physio and your surgeon for clearance. A return-to-sports assessment is required prior to sports participation.
Light duties can commence at 2 to 3 months, and return to manual labour / heavy duties is
expected at 4 to 5 months post-surgery.
The graft options
Here are the options we commonly use:
Hamstring tendon — single bundle
Most common ACL graft worldwide.
Uses two of your hamstring tendons.
Failure rate: <10%.
Side effects: some hamstring weakness, cramps, mild ongoing strain; kneeling discomfort in <10%.
Best for: low-to medium-demand activities, knees at risk of stiffness, or where some native ACL is healing.
Hamstring tendon — double bundle
Recreates the natural two-bundle anatomy of the ACL.
Failure rate: <5%.
Side effects: as for single-bundle hamstring.
Best for: medium-to high-demand knees, especially where kneeling discomfort would be a problem (tradies, gardeners, kneeling with young children).
Patellar tendon — bone-tendon-bone
Uses the middle third of your patellar tendon with bone plugs at each end.
Failure rate: <5%.
Side effects: kneeling discomfort in <20%.
Best for: high-demand knees, including professional and competitive athletes.
Quadriceps tendon
Uses a strip of the quadriceps tendon above the kneecap.
Failure rate: <7%.
Side effects: rehab is more demanding early on; potential for long-term quadriceps weakness.
Best for: revision (repeat) ACL surgery, and selected primary cases.
ALL (anterolateral ligament) augmentation
Performed alongside the ACL reconstruction in high-risk knees.
Purpose: improves rotational stability, reduces graft failure risk.
Side effects: can make the knee feel too tight or stiff.
Best for: young patients, pivoting sports, generalised joint laxity, or revision cases.