Can a torn ACL heal?

Traditionally, a torn ACL was considered unable to heal reliably and surgical treatment meant replacing the ligament with a tendon graft — an ACL reconstruction.

We now understand that some ACL injuries have the potential to heal.

In carefully selected patients, it may be possible to preserve and repair the patient’s own ACL rather than replace it.

Which ACL tears can be repaired?

Not every ACL tear is suitable.

ACL repair is most commonly considered when the ligament has torn close to its attachment on the femur and there is sufficient healthy ACL tissue available to restore the ligament to its normal position.

The location of the tear, tissue quality, timing of injury and evidence of healing all influence whether repair is appropriate.

MRI is important — but it does not tell the whole story

MRI helps identify the ACL injury and associated damage within the knee. However, determining the exact tear pattern and whether an ACL is suitable for repair can sometimes be difficult from MRI alone.

The final assessment of ACL tissue quality and repairability may therefore be made at arthroscopy.

Where appropriate, we aim to preserve as much healthy native ACL tissue as possible.

ACL repair versus ACL reconstruction

The potential advantages of preserving the native ACL include retaining the patient's own ligament tissue and avoiding the need to harvest a larger tendon graft.

However, ACL repair is not appropriate for every injury. Patient selection is critical, and reconstruction remains the more reliable option for many ACL tear patterns.

The aim is not to choose repair or reconstruction before understanding the injury.

It is to choose the right operation for the right ACL.