Operative Treatment Patients for whom surgery is generally recommended: Active individuals who participate in any sport with pivoting - such as soccer, tennis, basketball, football, or skiing Patients who continue to experience instability after going through a rehabilitation program Those with injuries involving more than one ligament It is important to consider the patient's commitment to the rehabilitation program following an ACL surgical procedure. This is especially critical if a meniscal repair is also required. The patient must agree to carefully follow the recovery timetable outlined by the doctor.

• range of motion is adequate
  
• swelling is reduced
  
• quadricep muscles are functional

It often takes about three weeks for the knee to reach this point.

Is there a simple way to repair the damaged ACL without a reconstruction?

In a direct repair the ends of the torn ligament are sewn together. This procedure is usually not recommended, as the ends of the ligament do not heal reliably. Direct repairs of the ligament to the bone may heal; however, this, also is not always reliable.

Extra-articular (outside the joint) procedures involve securing a portion of a tendon on the outer part of the knee (the iliotibial band) across the outside of the joint. This procedure does not reconstruct the torn ACL. It attempts to provide increased stability by placing a restraint on the outside of the knee. This procedure is generally not adequate by itself but it is occasionally done to provide additional support after ACL reconstruction.

Replacing the damaged ACL with a graft made of synthetic materials is no longer performed due to poor results. Many patients who had this surgery experienced reactions to the synthetic material as well as early failures of the graft.

An ACL reconstruction is the most common surgical procedure performed today since it usually produces the best results.